Report on alcohol and drug abuse

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Title:
Report on alcohol and drug abuse final report to the American Indian Policy Review Commission
Physical Description:
xix, 97 p. : ; 24 cm.
Language:
English
Creator:
United States -- American Indian Policy Review Commission. -- Task Force Eleven
Publisher:
U.S. Govt. Print. Off.
Place of Publication:
Washington
Publication Date:

Subjects

Subjects / Keywords:
Minorities -- Drug use -- United States   ( lcsh )
Indians of North America -- Alcohol use   ( lcsh )
Minorities -- Drug use -- United States   ( lcsh )
Indians of North America -- Drug use   ( lcsh )
Genre:
bibliography   ( marcgt )
federal government publication   ( marcgt )
non-fiction   ( marcgt )

Notes

Bibliography:
Bibliography: p. 77-86.
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Reuse of record except for individual research requires license from LexisNexis Academic & Library Solutions.
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Reuse of record except for individual research requires license from Congressional Information Service, Inc.
General Note:
At head of title: Committee print.
Statement of Responsibility:
Task Force Eleven: Alcohol and Drug Abuse.

Record Information

Source Institution:
University of Florida
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
aleph - 022411697
oclc - 02692401X
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lcc - KF49
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AA00022458:00001

Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    Title Page
        Page i
        Page ii
    Letter of transmittal
        Page iii
        Page iv
    Table of Contents
        Page v
        Page vi
    Task force summary statement
        Page vii
        Page viii
        Page ix
        Page x
        Page xi
        Page xii
        Page xiii
        Page xiv
        Page xv
        Page xvi
        Page xvii
        Page xviii
        Page xix
        Page xx
    Section I. Introduction
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
    Section II. Issues, problems, and recommendations in the Indian alcoholism and drug abuse field
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
    Section III. Appendices
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
    Section IV. Bibliography
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
    Section V. Addendum
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
    Back Cover
        Back Cover 1
        Back Cover 2
Full Text








[COMMITTEE PRINT]


REPORT ON ALCOHOL AND DRUG ABUSE




TASK FORCE ELEVEN: ALCOHlOL AND DRUG ABUSE


I' *! -


INAL R1iORT


STO Ttlk

AMERICd INht)IAN POLICY REVIEW COMMISSION
*


REzUBEN SNAKE, Winnebago-Sioux, Chairman
GEORGE HAWKINS, Southern Cheyenne, Member
STEV LA BourFF, Specialist


Printed for the use of the American Indian Policy Review Commission


U.S. GOVERNMENT PRINTING OFFICE
77-46 WASHINGTON : 1976

For sale by the Superintendent of Documents, U.S. Government Printing Offes
Washington, D.C. 20402 Price $1.5









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I



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I '

I
4.


AMERICAN INDIAN POLICY REVIEW COMMISSION
Senator JAMES ABOUREZK, South Dakota, chairman
Congressman LLOYD MEEDS, Washington, Vice-Chairman


Senator LEE METCALF, Montana
Senator MARK HATFIELD, Oregon
Congressman SIDNEY R. YATES, Illinois
Congressman SAM STEIGER, Arizona


JOHN BORBRIDGE, Tiungit-Halda
LOUIS R. BRUCE, MohawkSioux
ADA DEER, Menominee
ADOLPH DIAL, Lumbee


JAKE WHITECROW, Quapaw-Seneca-Cayuga
Executive Director
ERNEST L. STEVENS, Oneida
General Counel
KIREZ KICKINGBIRD, KioWa
Profeaeaonal Staff Member
MAX I. RICHTMAN


(II)


4-

IL


I


















LETTER OF TRANSMITTAL


AMERICAN INDIAN POLICY REVIEW COMMISSION,
CONGRESS OF THE UNITED STATES,
Washington, D.C., August, 1976.
AMERICAN INDIAN POLICY REVIEW COMMISSION,
Congress of the United States, Washington, D.C.
GENTLEMEN and MADAM: The Task Force on Alcoholism and Drug
Abuse presents to you its Final Report pursuant to Public Law
93-580.
This report contains the results of one year of fact gathering, hear-
ings, and on-site visits. Our recommendations are based upon the
analysis of our investigations.
As a medical, mental and social disease, alcoholism and the misuse
of alcohol and drugs leaves its destructive mark in some way upon
every Indian individual and family.
Without a continuing commitment by the Congress of the United
States, the devastating effect of alcoholism and alcohol and drug
misuse among the American Indian and Alaska Native cannot be
alleviated.
Respectfully submitted.
STEPHEN LABOUEFF, Jr.
REUBEN SNAKE, Chairman.
GEORGE HAWKINS, Member.
(III)

















CONTENTS


Pas
Letter of transmittal-------------------------------------------- III
Task force summary statement v------------------- VII
SECTION I:
Introduction----------------------------- 3
SBCTON II:
Issues, problems, and recommendations in the Indian alcoholism and
drug abuse field ----------------------------------- 11
A. Federal/State relationship and policies------ --------- 11
B. The Indian people, alcohol and drugs------------------------- 12
C. Scope of problem-------------------- --------------------- 15
D. Alcohol and drug abuse programs 18
B. Recommended legislative actions-- ---------- --- 20
F. Other issues:
1. Community and social impact------------------------- 22
2. Economic impact-------- -------------- 23
3. Prevention and preventive education --------23
4. Indian representation--------- ----------- 26
5. The law, alcohol, drugs and the Indian---- ------ 27
SBwnO III:
Appendices:
A. The Snyder Act of 1921------------------ 31
B. Historical information---- ------------------ 31
C. Excerpt from the Report of the Indian Health Service Task Force
on Alcoholism---------------------------33
D. Drug usage summary--------------------------35
E. Summary of letters received by individuals, programs and tribal
representatives in response to questionnaires ---------36
F. Statistical information----- ----------------39
G. Program description of Federal, State and local agencies------ 45
H. An alcoholism program built around a comprehensive health model_ 58
I. Veterans' Administration Study on the Feasibility of Combined
Alcohol and Drug Treatment Program ---------------62
J. Excerpts from "The Alcoholism Report" ---------------------- 62
K. Excerpt from report of the Committee on Interior and Insular
Affairs, U.S. Senate--- ----------------- 62
L. Summary of task force hearings --------------- 64
SeCTION IV:
Bibliography--------------------------- 77
SECON V:
Addendum ......
A. Decriminalization of alcoholic related offenses-- --------89
B. Special report: Removal of Indian Children from Natural Homes
and their Subsequent Placement in Non-Indian Foster or
Adopted Homes------------------------- 91
C. Specific correspondence------------- ----- 93










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Ii& k'... TASK FORCE SUMMARY STATEMENT

Because the alcoholism movement is of so recent evolution, the
American Indian Policy Review Commission is of the greatest im-
pCt acl: not only in readjusting the Indian and Native Alaskans
Wt tdtl society but also in getting the alcoholism movement
pM t~~i hie right direction.
A WoI- terms are useful in discussing alcoholism and other drug
a6m.:'.ate is institution and one is movement.
1 1WI' Boadsest sense, institution means doing things in the accepted
way ,in a society. For example, hospitals are the institution of health
and all of their elaborate efforts are designed to restore patients to
wsi |gnpy]ements arise when institutions are not working to the
si4 tidon of some groups. These groups then organize and make a
ai. effort to modify, maintain, replace or destroy the institution
~on.,,:i
7& usefulness of the two key terms may be seen in the following
wqys, Inuthe recent past, health institutions did not work to the satis-
N J Yt upb interested h alcoholism. An alcoholism movement
fdttwt restore health to the alcoholics, primarily because of the
failure e institutions to do so.
::Snoos movement arose because of a stigma and its conse-
hilnl J? ether it retains its form as a social movement or becomes
aj rn 'the instpiution of health or disappears altogether depends
ittaofler of factors.
Sif `6epprt will concern itself within the context of the unique
FederTdian relationship which recognizes certain Federal re-
i%....y.to the Tribes, including special services to Indians be-
ckftb tlbir statis as Indians. Such services are predicted on treaties,
MtltadA t decisions, rather than on race.
^Tadigrce No. 3 has addressed itself to the question of "Federal
AdIitiration and Structure of Indian Affairs," and has punted
o t th Indians' inherent right for sel f-government.
nga'4 problem as perceived by Taisk Force No. 11 is to bring
AllAl'li cohol and' Drug Abuse to the attention of this Indian
S Itotmental structure "d to the individual .Indians. These
poles have been readily idbeAtified as being the Numtiber One
prlem affiting the Indians and the Alaska Natives, but the
dbkfltve remeant ^within this commui ty still views these problems
iii light of a Moral Issue and not as%& a respectable and treatable
dieae and threor this pctb
disease, and therefore this problem generally falls into. the lowest
ib plit, 4W0a (or reoopition of the problem of Aldoholism
W ii~tS d m tl fo16 f colics Anonymous in "935, and
fft B y e1e Lsa f the "Hh gheW Act," Public Law 91-616
Dec'nb iTo
: i'. "*i ;:- : ^ -: .r ; '= -(V fil) .






VIII


"Hard drugs" do not seem, except in some isolated areas, to have
reached the problem intensity of alcoholism, but the emergence of
drugs other than alcohol, especially among youth, is creating
a great amount of concern.
Out of this heightened awareness of the problem, Drug Abuse is
now beginning to receive the attention, resources, and recognition as
a disease which it has previously lacked.

FACTORS-PROBLEMS AND ISSUES
The problem of "anonymity" of the alcoholic has finally been
resolved at the national level by the establishment of three (3) insti-
tutes under the Alcohol, Drug Abuse and Mental Health Administra-
tion (ADAMHA). Although tremendous strides have been made, the
disparity of the alcoholism movement may be viewed, at the national
level, by this tabulation of ADAMHA:

Financial
resources
Institute Personnel (fiscal year 1976)
NIAAA--.-..................------------. -.--------- 195 $151,305,000
NIDA------------------ -- ----------- 397 232,170,000
NIMH--..--.................----------------------------. 895 418,589, 000

Although drugs other than alcohol seem to garner much of the
Administration's and Congress' attention, (their being an esQteric
and vote getting subject), alcohol is still the No. 1 problem.
At the inception of the alcoholism movement (Federal level) it was
originally placed under the Institute of Mental Health. One of the
basic reasons that a long hard look at alcoholism is so necessary is
that it is a matter of record that the vast majority of alcoholics who
have recovered have done so outside of, and in spite of, the mental
health movement rather than within its therapeutic boundaries.
In a Congressional hearing during the period before the reorgani-
zation which moved the NIAAA out of the Institute of Mental
Health, Mr. Ken Eaton, former Deputy Director of NIAAA, stated
that alcoholism is "not a mental health problem," and that, "the
psychiatric approach to alcoholism is not only the most expensive,
but probably the least effective."
The diffused appropriation and/or allocation of funds for the
alcohol and other drug abuse problems (which Indians could utilize,
presumably they are used in the over-all head count) is phenomenal,
e.g., DHEW (NIAAA, NIDA), Department of Justice (Juvenile
Delinquency, LEAA) and Department of Transportation.
The devious or alternate routes of getting needed Indian programs
funded, is exemplified by Mr. Burns' testimony. (Phoenix Hearing,
p. 116).
An identifiable and permanent Indian alcohol and drug abuse
entity is needed as a strong advocate for policy determination at the
national level. Valuable time which could be devoted to the problem,
is exercised by the Directors and Boards of programs, to funding
problems. They are so deeply enmeshed in funding politics that it has
become a serious problem. But they have had to do this to survive.





IX


n"rr sba Cd rural (reservation) problems in funding would be lessened
sad'&o-ptative efforts would be enhanced if funding politics were
eluinated. The problem here, it appears, is that there is considerable
6t*h.t9 about ftrban programs taking from reservation programs,
wlt.s anpetition should be based on needs. (J. Hayes, Phoenix
lfiiftgp.59)
Also within the Tribal Area, there must be more cooperation by
trlMWMities. When an individual moves from reservation or home
t *ieWfce does not go along. (McCabe's testimony, Phoenix p. 42;
....bse, Salt Lake site visit, p. 10).
^., ^ee of Education.-The Administration, at the local level,
l :A a great deal of resistance toward any alcohol or other drug
s04tieffort, whether having special programs or inclusion within
fi~~eNinulum. NIAAA awarded Chilocco Indian School a grant for
"hilocco Alcohol Education Program," but differences of judgment
WbriB the school administration, Grantee (Chilocco Advisory School
BBower) d the Program Administration caused this program to lose
Ml. tding. (See Att. file; Ms. Nez's testimony, Salt Lake City, p. 1;
BIA fesidential School Analysis, fiscal year 1976-1975-76 School
Year).
: ?T mS..There is reluctance of local staff to administer or cooperate
wli.the alcohol and other drug programs for treatment. One of the
'64ity reasons is lack of empathy, possibly resulting from not fully
aN Ai alcoholism as a disease by the individual and/or lack of
al Only five (5) University Medical Schools offer any training
Th tscplinary training must be instituted.
tiM i ce of medical personnel to diagnose alcoholism is a primary
fact. (Siblix City, Phoenix and Anchorage Hearings).
Vkras_' Administration.-Efforts are mostly rhetoric, and from a
practical standpoint of the Indian Veteran nothing has been done.
( si -e on V.A. submitted to Commission; testimony by Ms.. M. D.
Trtk, Window Rock Hearing).
S owe Civil Service.-Same category. (see G. Retholtz, Ph.D).
t~itk efforts were mandated by Congress in Public Law 91-616,
t little progress has been made.
d c.o-We may be raising another generation of Indian alco-
hol, ard one of the primary factors could be the local statutes and
ezagaMions (State) in which Indian children are placed innon-Indian
fotsrhoines. (B. Albaugh's paper submitted to Commision; hearings
it At Lake, Oklahoma City and Sioux Cit).
PWgotten Children.-Concern is being voiced for a group who have
b! termed the "Forgotten Children," aged 10-16. Some of the many
unanswered questions:
Aie the children more severely damaged than those in the
troubled homes?
S. Is harm to children related more closely to drinking or the
quality of the relationship between the alcoholic and his spouse?
Should the family be treated as a whole?
S Would this produce a more complete recovery for the alcoholic?
S Would it 'produce a lower rate of alcoholism, later on, in the
children?
.. ". .. ... .






When the alcoholic and the spouse refuse outside help, is there
any way in which assistance can be given separately to the
children? .
Alaska.-A very serious problem is developing here. The pipe line
would leave the natives in a cultural vacuum-with nothing left of
their natural resources but a polluted environment and broken
health.
Communication and accessibility of any assistance is critical. In
our site visits, one of the pointed problems was the language barrier;
even though the Task Force was Indian, we still had to have a.qn
interpreter to communicate with the Native Chiefs and elders.. One
of the basic solutions offered by the local people was the effort by
NIAAA in their Mini-Grant program. Our conclusion was that this
would be the most feasible; it would seem to give the local people the
opportunity to resolve local problems.
States.-The States do not seem to know what to do with their
alcoholism effort. Kansas has it under "Social Services," Oklahoma
has it under "Mental Health" and New Mexico under "Department
of Health Institutions." (See position paper submitted by State of
Washington, Submitted to Commission).
Indian input on States' alcoholism policy.-Tokenism seems apparent.
(Sioux City Hearing). In this Task Force Member's experience, seated
on the Oklahoma Alcoholism Advisory Board, no input into the
"State Plan" was presented. Advisory Board has "review and com-
ment on grant applications," but this concerns only "Formula Grant"
monies received through NIAAA, no state monies appropriated by
state specifically for alcoholism programs, although State Plan indi-
cates "The Department of Mental Health expended approximately
one-third ($6.5 million) of its entire budget for last fiscal year for
alcohol-related treatment and rehabilitation in its three mental
hospitals."
With the built-in "denial syndrome" of the alcoholic, it certainly
deters the individual from seeking help in a state mental institution
because he immediately associates it with a "crazy" or "Nut" house.
Municipal Constituencies.-For example, see the attached letter
from Coal County Economic Foundation, Inc. After being funded by
NIAAA, an attempt was made to locate their treatment center in
Atoka which supposedly was meeting local ordinances and zoning
requirements. During our interview with the former Director, he
indicated (but it is not revealed in the letter) that a group of citizens
(neighbors) petitioned the City Officials to restrict this type of facility
from their area; they didn't want a bunch of drunks around. After the
facility was placed at a site other than Atoka, the City fathers reversed
themselves and re-zoned it to its former category.
Insurance.-This Task Force member, while Director of the
Cheyenne-Arapaho Alcoholic Rehabilitation Center, in Bessie, Okla-
homa, had an insurance policy (1st year) with the designation as a
Rehabilitation center, with the premium set at $338.00 per year. The
following year we received a notice that the insurance company had
reviewed our policy and we would have to be designated as a "Mental
Psychopath Institution-Governmental" at a premium rate of $109.00
per bed, (20 beds), a total of $2,018.00.
One of the basic questions that confronts the Indian Alcoholism
effort is the policy and procedure of other disciplines, i.e., Social





XIf


^ E b.xit and clinics, which involves the Tribal entities,
Av Boards, etc. They feel that the financial resources will be
31-1their objectives.
..fau financial resources (NIAAA, IHS, BIA, LEAA, Justice
alampiet, etc.) and policies and procedures were concentrated
jiAtslo entity, it would certainly be more effective. Heretofore,
,prqsmu3had to staff (or assign) a position to keep up with available
ludg'iturces, proposal writing and'advocacy. Boards of Directors
N.4 P. gr.am Directors are continually having to find and promote
"4litiqa agreements" with other sources of resources, whether
nancial or technical. This promotes competition within areas and/or
puqras and the amount of assistance given (although it may origi-
nate from a central source) depends on the local interpretation of
o .s.a.d procedures. Examples of this are: I.H.S.-Billings area
*std tuneures
$Q*41ifuxs for the establishment of detox units (the only area in
"ch thisR was down) not because it was a priority but because the
fund 'were in excess over the immediate needs of the area. This
cre A r qmtp a controversy among other areas.
Tb B.I.A.-Social Services contracted, from General Assistance
iEnth American Indian Special Services Project to assist their
a .tmapncially by paying $5.00 per day per man; Cheyenne Arapaho
AIc Rehabilitation Center, contracted $3.00 per day per man;
Qp9 L.outy Economic Foundation, Inc. was refused this type of
.JU JUISPRUDENCE
hewing Mr. William Stoneroad, who in turn had interviewed
25 inates of the El Reno Federal Reformatory, El Reno, Oklahoma,
7.i Tb61'Vations were made: (Mr. Stoneroad is Indian and counsels
ii"la]d on a voluntary basis).
Sincq this is a'Federal Reformatory, they received their charges
fmr':l over the nation. Most of the inmates come from a reservation
environment, originally, but we could not pin-point whether the
=NileMw which caused them to be incarcerated occurred on or off the
reservation; a reasonable assumption would be that it occurred off the
U0ifm ates interviewed.
" M.i o.tge--25 years.
S! ( iit t did not seem to have criminal personality profile.
s: (Iteriewers do not have academic background to scientifically
evaluate)
SAl the instant of the incident for which they were incarcerated they
stated they were in acute alcoholic condition. All 25 gave a positive
answer tothis question.
*When questioned as to why they drank these were the responses:
1. There was nothing else to do on the reservation.
2. Lack of employment.
: 1nfdZiotoniplex, caused by:
Attitude of teachers, while in school.
Lack of skills to cope in the outside society.
5. Insecurity.
6. Males drink, only social activity.





XII


They felt as if welfare aided and abetted their chronic alcoholism by
supporting them and their families.
The training (job skills) they received while institutionalized was
not relevant to what they might use when returning home.
Most seemed passive and felt they would have to do all of their time
and would take whatever assignment given them, with the attitude
of "why fight the system, I'll titke what they give me and do my time."
They were not able to file appeals while in the institution, as some
of the other non-Indian inmates were doing, because they did
understand the appeal procedures and their rights (while in prison)
were never fully explained to them.
Recommendation: Indian counselors and Ombudsman-More access
to records of individuals.
Mr. Charles Kaubin, Counselor, Haskell Indian Alcohol, Education,
Prevention and Treatment Program, Haskell Jr. College. (Sioux
City hearing, Pp. 157-158). Counsels with inmates, Leavenworth
Federal Prison. (Voluntary)
Most of inmates appearing before Parole Board are refused parole
because of lack of preparation.
Need for an Indian parole counselor. It is hard for an Indian coun-
selor to develop a relationship with the inmate, almost impossible for a
non-Indian to establish rapport.
Most Indians turned down for parole; lack of personal resources,
i.e., education and training. Perceives need for T.V. instruction (avail-
able in prison) to include basic skills, i.e. letter writing.
Parole Board's primary criteria is based on inmates' job potential.
Most Indians do not have this.
55 inmates identified; 51 were incarcerated for alcohol related
reasons and crimes that were committed during the time they were
intoxicated or under the influence of drugs or alcohol.
Recommendation: See Appendix "G", Leavenworth Education
Program.
Mr. John Poupart, Director Anishinabe Longhouse, Minneapolis,
Minn., extension of Minnesota Department of Corrections.
Anishinabe Longhouse is After care from a penal institution. In a
two year period, out of a total 100 individuals, 6 percent became
victims of recidivity. However, before Anishinabe, 57 percent were
convicted of new crimes and sent back to penal institutions. Although
this is not a fair comparison it would indicate a very good response at
Anishinabe for recidivism.
Poupart expresses fear that Attorney-at-Law will promulgate
legislation that will not be in best interest of Indians.
Does not receive support of Indians.
Rejects assumption Indians received trial by jury of their peers:
(a) Indian people do not vote.
(b) Juries are drawn from registration lists.
(c) Although a greater percentage of crimes are committed by
Indians, there are no Indian police-Non-Indian judges and
probation officers-non-Indian wardens and deputy wardens.
Police brutality, with no recourse.





XIII


Pre-sentence investigation looks at the following:
N.. You didn't finish school-bad mark.
Y u don't have a skill-bad mark.
S. .Yout don't have a permanent residence-bad mark. (Keep
going back and forth to the reservation, you can't find a home
adt settle down).
i, u don't have a job-bad mark. (65 percent of people on
Sresicvtion don't have jobs).
'Ye.. don't have a credit rating-bad mark.
(Io.hyptem never looks to the reason as to why they dropped out of
s9)ool Dropout rate 6 times greater than other ethnic groups.
-Rtormmnadtion: Re-evaluation of pre-sentencing procedures and
ppa.q system. More traiining for individuals who have a decision on
these Ma"ters, if other than Indian.
Orville E. James; Associate Warden (Retired), El Reno Federal
Reformatory. Address: 1602 Ridgecrest, El Reno, Oklahoma 73036.
Tel 4406)-262-1391. (Could be further utilized as Consultant.)
Work release programs in states should be further developed.
Reticence of Indian inmates to staff. No rapport.
Attitnuls of staff are very negative.
Eaotsendation: Pay advisors small fee to work with parolees;
senior ;citizens could be utilized (Indian). Training (Orientation) for
thwds' 1 os. Entire prison system should be over-hauled.
Lawnce Hart, Director, Committee of Concern, Inc. P.O. Box 173,
litm, Oklahoma 73601, Tel. (405)-323-4111.
Has two (2) Programs:
1o^. Indian Offender Rehabilitation Program. Funded BIA.
2. Adult Misdemeanant Program. Funded LEAA.
9&, percent of the clientswere convicted for alcohol related crimes or
pe ei d while intoxicated.
l. U other than alcohol, are not too prevalent.
Idid.ao are not fully apprised of their basic rights or do not fully
undstaM these, e.g., a ninety (90) day period in which they can file
ab appeal-the majority do not avail themselves of this procedure.
allhul the Committee of Concern is an advocate, they do not learn
of the inmates' predicament until the ninety (90) day period has
l~t~]Hprt recommends an Indian Counselor be provided to make
these available to the inmate. He is very distrubed about the in-
adequy of court appointed attorneys; sometimes when the charged
is able to post a bond, using friends or relatives, the judge will not
t a, attorney to represent the client, taking the position that
S.51ciz post bond they can certainly get a lawyer.
x wmmends a legal aid society for Indians. When an entity such
a. h4as tried to organize, they encounter formidable resistance from
thCkraty Bar Associations.
ki sthe courts, and the medical profession now recognize that
alwoo is a major disabling illness. Therefore, the Task For'e believes
that revision of the Federal Criminal Code should explicitly provide that
alcohism is a defense to prosecution, under Federal law to the same
extent and under the same conditions, as mental illness. Such legislation
u;d substitute appropriate treatment and rehabilitation under civil
law for punishment under the criminal law.





XIV


[From the "Alcoholism Report," 6/14/74]:
In a case dramatizing lack of treatment in penal facilities, the city of
Cheyenne, Wyo., has been successfully sued and ordered to pay $70,816.48
in connection with the death of an alcoholic who spent nine days in
the city jail without medical treatment.
The suit was brought by the estate of Donald Leon Ellis, a 49-year-
old alcoholic who died December 9, 1971, after his arrest and sen-
tencing on a public drunkenness charge. G. L. Spence, Attorney for
the estate, brought the suit under Wyoming's Wrongful Death
Statute, claiming that the city was negligent in failing to provide
medical treatment or proper food and sanitary conditions during
Ellis's incarceration.
During the trial, witnesses testified that Ellis went through delirium
tremens, was given only wine and aspirin, and allowed to remain on
a concrete floor. In addition, Ellis suffered from advanced liver
cirrhosis. No medical help was called prior to his death.
A jury of seven men and five women returned a verdict against the
city February 1 in the Laramie County District Court. The verdict
was not appealed.
Robert A. Moore, M.D., Medical Director of Mesa Vista Hospital,
San Diego, Calif., an expert witness in the case, wrote AR that
"the monetary aspect was not the issue but rather the attempt to
prevent future mistreatment of alcoholics in jail." Its outcome, he
added, "is certainly a hopeful sign and it might encourage lawsuits
in other areas where the Uniform Act 1 still has not been passed into
law."
Comes now Peter Fong, a physicist at Emory University, with a cure for
almost everything:
Double the corn crop acreage. Use the corn starch to make ethanol
(say 20 percent) with gasoline. There goes the energy crisis. Feed the
protein and oil from the corn to animals. That lowers the price of meat.
Use the liquid effluent from sewage plants to fertilize the cropland. So
much for water pollution. To handle the farm chores, move the hard-
core unemployed from the ghetto (ending slum problems) and establish
them on the corn farms, where each family would distill its own
alcohol from its own crop.
"With an abundant supply of alcohol available, the only problem
left," he said, "is to prevent ourselves from drifting into a nation of
drunkards. But this seems to be the least of all evils."
Dr. Fong presented his utopia, seriously, at the national meeting of
the American Physical Society in Washington.
In Powell v. Texas 392 U.S. 514 (1968), the Supreme Court affirmed
the status of alcoholism as a disease, even though Powell's conviction
was upheld since the record failed to show that he was unable to avoid
being intoxicated in public. The Court deplored the inadequacy of the
governmental response to the national problem of alcoholism and the
severe shortage throughout the country of facilities for the treatment
of indigent alcoholics.
I In Task Force papers submitted, See "Status on Uniform Act."





Xv


..Pi "" EPIDEMIOLOGY

Ehwpn wlA. -mgure on alcohol and drug abuse is an elusive one. The
vq h tft4he "Denial Syndrome" among alcoholics and the question
otealtt n. other drugs makes the figure, as previously stated, a very
e~lAv e'a, fice most of the individuals who have these problems
ea"s tietatistical sources which would generate a national total.
h tklisponMt the sources of information on alcohol and other drug
uigwAM ?umtrous but of unequal quality and usefulness (M.
Lkout-Alcohol Technical Reports, 10/75). Random investigations,
vi stetaics, hospital records, court records and fragmented records
of ting alcohol treatment centers can be and have been used
foe a dtwination of use and abuse. No single agency collects
information on all aspects of the problem among Indians and Native
laI~Nt, ior does one agency have access to all sources of information
wdiihT may be available. (M. Smith, testimony-Sioux City, p. 86;
Comparative Studies and Their Problems, J. Westermeyer, M.D.
Ph. D.-News Letter, Association of American Indian Physicians,
6/76) P
SDo we kiiot why there is a reported higher incidence of alcohol problems
among I ians, as compared to other races?
We .would make three (3) recommendations:
1. Dbuioti on Alcoholism, Alcohol and Other Drug Abuse
LEstb-s 'a distinct function, within the Indian Governmental
Structure, which would have a stature commensurate with the magni-
tude i the problem with which this new entity would deal. Conse-
qtto[g 1,4e likelihood of obtaining the funding necessary to effectively
attack the Alcoholism, Alcohol and other Drug Abuse problems will
be imeasurably increased. This Organization would also have the
vj t$J tie essay to provide a strong program of public education
a too develop public attention to and concern about this problem.
In addition it would have a permanent status which would assist in
the development of the most qualified staff possible in Indian self-
goe Imbnt structure.
-(d) Convene a National Advisory Council (Indian) to establish
gui:Adelines and criteria to act in a policy definition and oversight
capacity to this function. Composition could possibly be 40 per-
iteiSTrbal Government and Treatment Providers; 60 percent
Consumers.
S, (b). Esblish an Indian evaluation board to periodically moni-
tor sad evaluate the programs.
G(O St.up structure that would establish permanent programs
1an UOaitins for personnel.
4 '.j! Tri ovie operation and maintenance moneys.
'i: (e) There must be a balanced and parallel thrust between
research and programmatic approach.
t.Research .1
This could provide a foundation of facts on which intelligent,
planned alcohol and drug treatment programs might be based. Intense
and better-financed studies are critical m these areas. But we cannot
r#\w~fto'p ivet ^ programs until such studied are carried out.
Tfiirobem s, prwnt, severe, and demands immediate.attention.
". :I I ;i




XVI


No clear-cut definition of "Alcoholism" exists among Indians. Per-
haps the body of knowledge and expertise about "alcoholism" now
being disseminated is not relevant to Indians. The etiological de.ii-
tions enunciated by Jellinek (and subsequently amended and dev.l-
oped) does represent a body of knowledge; but it is based on studies
within the industrial societies where it was carried out. It is thq result
of "white" research, "white" criteria, "white" program goals, apd
"white" nomenclature. Consequently, the expertise and treatment-
response based on such knowledge may be inappropriate, even if
programs are "adapted" and "interpreted."
The projection of service programs for Indians is not and cannot be
adequate until concise operational definition of "alcoholism" is aiyail-
able. (We are now utilizing such expertise by sending "s amplified"
instructional literature to illiterate (in English) communities.)
Do we know "what and how" we are going to prevent and ediuate?
We recommend that the "Plan A" be instituted (found at the end of
this section).
31 Programmatic
The continuum of care for the individuals with these problems is
almost non-existent, primarily because of the lack of resources, both
financial and staffing.
We would recommend that the programs follow the recommenda-
tions as set out in the "Accreditation Manual for Alcoholism Pro-
grams" as promulgated by the Joint Commission on Accreditation of
Hospitals.
What is considered the core unit of a continuum of care is the
"Intermediate Care Unit" (Half-way house). (The standards as
promulgated by the Association of Half-Way Houses of North
America could be utilized).
These are only general guidelines and the implementation of the
therapeutic modalities within each unit must be at the direction of the
local unit.
Standards (as we know them) must be established for accreditation
and certification. J.C.A.H. criteria may be used and the certification
as advocated by Region VI and John Mackey's committee may be
used. (The National Indian Board on Alcohol and Drug Abuse is in
the process of formulating these measures)
These areas could be addressed in conjunction with the respective
task forces:
Task Force No. 5-Curriculum. Student rights, specifically when
students are expelled for alcohol or other drug
abuse problems, where do they go for help?
Task Force No. 6-Training or re-training of staff to gain insight of
patients with these problems-"Attitudes." Re-
search into "Fetal Alcohol Syndrome." (Pre-
liminary paper by B. Albaugh, att.)
Task Force No. 7-Should industry have built-in programs to address
these problems?
PLAN "A"
An important objective of Task Force 11 is to delineate the role of
alcohol in the life of American Indians, in particular to examine (1)
Indian drinking patterns, (2) the effects of Indian alcoholism, (3)





xvU


drug abuse problems, and finally determine the effectiveness of treat-
m;t programs for alcohol and drug abuse.
The most suitable mechanism fopr this investigation would be a
cross sectional survey of the American Indian population designed
to examine the role that alcohol plays in the life of the American
Itii*a. number of anthropological and sociological surveys and
studiBs hae, been conducted among selected tribes. These studies
hate a number of limitations; among them their incompleteness,
and limited scope; a major deficiency of these studies is that they
Wer civum cted by non-Indian social and medical scientists. In keeping
wit it -e objectivee of this Commission, which is to have Indians exam-
ine and document the condition in Indian country, we recommend that
suhi a. survey be conducted by Indian people utilizing professional
experts min the areas of alcoholism research, sociology, and survey
remnh.. The following is our suggested plan for this survey.
ANTICIPATED DIFFICULTIES
A, :mber of problems have plagued attempts to conduct social
surveys' among the Indian population and to measure problem drink-
ing among this population. They are:
1. Language barriers
Th re re literally hundreds of Indian languages, and it is esti-
mate^Sbaapproximately 25 percent of the population to be surveyed
Vis .ueat m the English language, and would have to be inter-
vip j their native tongue.
5. weNhml diffJerenc
The studies of alcoholism and definitions of alcoholism that have
bees. reloped for the general population are culture bound. Indian
st8% o1 le, values, environment and drinking patterns differ signifi-
cII* from the general behavior patterns, and survey instruments
d f to measure the general population use of alcohol and prob-
le r!ating "to alcohol, are not appropriate to significant proportions
of tt Indian population.1
t, ?pulation dispersion
4|e|Indian population, except for a number of urban segments, is
id F.scattered in rural and reservation areas. Previous studies
h enqt had the time and money necessary to complete interviews in
faM cing parts of the country.
4Diffity in interviewing Indian population
an' intla erviewees generally have a difficult time relating to non-
Izdianxiterviewers or to interviewers of another culture. Furthermore,
the Indian population is understandably suspicious of Indians and
non-Indians who represent the "Power Structure."
o elap-eut definition of "Alcoholism" exists. Perhaps the body of knowledge and ex-
about "alcboholsm" ow being dismminated ts not relevant to Indians. The etiolog-
q d tons enunciated by Jelnek (and subsequently amended and developed) does
.e :t a IMdy of knowledge; fnt it Is based on studies within the industrial societies
,,g ..It.. e rsed u t, It is the result t of" white" research, "white" criteria, "white"
gems, and 'hlte" nomenclature. Consequently, the expertise and treatment-
rvre pCgtaed on such knowledge, may be Inappropriate, even if programs are "adapted"


77-466-76---2





XVIII


5. Interpretation of study findings
Most previous studies have been interpreted by non-Indlans not
familiar with the unique situation of the Indian population.
6. Diversity of Indian population
The Indian population is not a uniform ethnic group. Style of life
and culture vary significantly among tribes. Some studies have been
limited to one tribe or a few tribes, and their applicability to the
general Indian population is suspect.2
With these major obstacles, we recommend the following plan: The
survey team would be comprised of the following kinds of specialists:
1. Indians learned in the social sciences.
2. Indians possessing expertise in the field of alcohol and drug
abuse.
3. Experts in the field of alcohol and problem drinking research,
preferably scientists who have conducted cross sectional surveys
to identify and measure the extent of problem drinking.
4. Survey research specialists who can deal with the problems
of sampling, interviewer training and recruitment, survey data
productions and statistical analysis.
INTERVIEW CAPABILITY
There are 151 NIAAA funded centers covering at least 90 percent
of the Indian population. This field force represents a potentially
unique facility for conducting survey research among the Indian
population. They are trained counselors who are themselves Indian
and members of the Indian community to be served. These counselors
are already equipped to operate on a bi-lingual basis. The counselors
are not part of the general tribal power structure, but are respected
members of the community with whom the people have rapport. We
feel this staff could be recruited and trained to conduct cross sectional
surveys among the population they service; however, we fully recog-
nize that any such group will encounter some difficulties in completing
all interviews necessary and obtaining valid information. A question
that we have is whether by being defined as alcoholic rehabilitation
counselors they might inhibit honest and fair responses about drinking
behavior. It was the general consensus of the Task Force that this
problem would be minimal. We recommend, however, that this assump-
tion be tested by conducting a pilot study where interviews are con-
ducted by counseling staff, and by staff of recruited and paid inter-
viewers. Results of these two forms of interviewing would be compared
to attempt to determine the extent of difficulties to be encountered
by utilizing the staff, and to determine the extent to which the staff
might be better interviewers than other types of interviewers.

SECONDARY RESEARCH
An extensive review of the literature on Indian drinking behavior
has been made by the Task Force. From this review, a delineation of
Indian drinking behavior would be made which could be tested by the
survey itself.
SKnott. David H. M.D., Ph.D. A Comparative Evaluation of Several Current Issues,
Submitted to Task Force 11, May 21, 1967.





XIX


SURVEY TASKS
Task 1-Establishing a sampling plan
In developing a basis for sampling the Indian population, a key
question to be resolved is whether the sample will be the general
Indian population or a series of samplings among tribes representative
of Indian cultures. This determination would be made by the Commis-
sion. The development of a sample universe will involve obtaining
most readily available information compiled by Task Forces 2, 6, 7
and 8 concerning the distribution of the Indian population.
Task B-Drawing of the sample
An area probability sample of the Indian population would be
drawn based upon the decision made in Task 1. This area of popula-
tion sample would be drawn to conform to the general location of
NIAAA funded programs. We do not feel this would be a difficulty,
as the NIAAA program distributes as the Indian population distributes.
Each of the drawn primary sampling units, map areas and other
descriptive materials would have to be obtained for household selec-
tion within each Primary Sample Unit. We would assume that a
great deal of this information is already available.
Task --Sample design and sample sze
A determination of total sample size would be made based upon the
specific objectives of the study. On the basis of which approved
general cross sectional Indian population or selected tribes was chosen
or the purpose of this document, we are assuming a sample size of at
least 2,500 interviews. The sampling would be of ful probability
design with a random systematic selection of households and enu-
meration of households in designated areas. Furthermore, the selection
of a respondent within a household would be on a random basis. Our
intention is to limit the sampling population to those 16 years of age
and older. Numerous call backs would be made to complete interviews
with designated respondents.
Task 4-Recruitment and training of interviewsfor NIAAA centers
All interviewers to be utilized in this project would be trained in
the execution of the questionnaire and sampling procedures to be used
by a field training supervisory team.
The questionnaire would be developed and tested by relevant con-
sultants, and its objectives approved by the Commission. We would
anticipate an extensive structured personal interview questionnaire
which would probably take an hour to administer. A small pilot study
would be conducted to test the instrument and test the abilities of the
interviewers as noted above.
Task 6-Processing the data survey
Questionnaires would be coded and key punched in preparation for
statistical analysis.
Task 7-Survey analysis and report
The survey data would be analyzed and reported by the Commis-
sion, utilizing appropriate consultants.






























SECTION I
INTRODUCTION












Iftch 1:: -*. .
,- L... i ;4 -I *,* -
Evil *
,.. I H iB <"' *' .... .

) 3 J INTRODUCTION
, "nn *ri mA. TASK FORCE No. 11
congress passed Public Law 93-580 on January 2, 1975, a Joint
estblishing the American Indian Policy Review Com-
aIIo I. ts purpose was to "conduct comprehensive review of the
zwtqial and legal developments underlying the Indians' unique re-
Watisbip with the federal government in order to determine the
u and scope of necessary revisions in the formulation of policies
and 'programs for the benefit of Indians."
The vehicle of investigation was to be through small task forces
working independently in different areas of Indian affairs, such as
trust responsibility, tribal government, education, and health. Al-
thanugh primarily a health problem, a separate task force was created
to dlimine the scope of the destructive use of alcohol and other
42y by Indian and Alaska Native people.
T i most important responsibility of Task Force No. 11 was to
powide the basis for the Commission to make recommendations for
e1epary ogram, policy and legislation changes which would be
mos rnponsive to the needs of the Indian people who do, or will have,
alcohol ~r drug use problems. This could only be accomplished by
looking at the full spectrum of the Indian way of life and those ex-
teami factors which influence their environment. Toward this end,
the Task Force held field hearings and on-site visits to alcoholism
putp1ams; conducted an extensive literature and research review,
enm6mded existing and proposed legislation, analyzed federal, state
ad lela :Salcoholism and drug programs, and used whatever means it
coh.t46 determine the scope of the problem.
l..fl
.. B. SCOPE OF THE PROBLEM
.. 1. HISTORICALLY
Tw use of alcohol and drugs is not a new phenomena among
American Indians and Alaska Natives. However, early usage was pri-
uwil 'limited to ceremonies and religious rituals in a closely con-
tr~~ qqcial setting. Early frontiersmen and traders offered distilled
bq.~wpgesrs gestures of friendship; unfortunately, the riches of the
v~Ia soon led those not so scrupulous to the exploitation of the
Inopople by offering whiskey, rums, or brandies in return for
ed possessions. Many were induced to consume the liquor
S reached complete intoxication, then their goods were simply
takien from them.
Historians note the terrible effects upon the Indian community
from use of the alcohol beverages. Although acts of aggression to the
AajWi and community were common, the Indian community had no
traditional way of coping with the actions of thbir people while under
S, '. :, : : ': : (8 ) :








the influence of liquor. While not socially accepted, the intoxicated
person was not considered in control of his actions, and the tribal
system was unprepared to administer strong restrictions or mete pun-
ishment to individuals drinking or intoxicated.
Congress passed legislation in 1832 prohibiting liquor traffic to and
among the Indian people in an attempt to stem the increasing flow of
problems attributed to the misuse of alcohol. Enforcement efforts of
those laws were unsuccessful, and bootlegging and smuggling only
became another form of exploitation by the non-Indian people.
The Indian people were given full citizenship by 1924; however, it
was still illegal to serve an Indian liquor until the repeals of the federal-
Indian liquor laws in 1953.
The ill effects of the introduction of distilled beverages into a socially
unprepared society and resultant measures at control by a dominant
society have played an important role in the formation of destructive
drinking patterns by Indian people.

2. TODAY
The past twenty years have seen a growing awareness by all people
of the United States of the devastating effect of alcoholism and alcohol
and drug abuse upon it as a society. Alcoholism and alcohol abuse,
a social, mental and physical disease, has a total effect almost im-
measurable. It is estimated that there are nine to twelve million
problem drinkers in the United States today-approximately 3 percent
of the population. Also, the use of drugs has increased sharply in the
past ten years and is now beginning to receive recognition as a major
social and health problem, as well as a criminal action.
Nowhere is the effect of alcohol and drug misuse more prevalent and
visible than among the American Indian and Alaska Native.
In a report by Indian Health Service (1970), it was stated that
"Alcoholism is a costly proposition in every sense of the word. Personal
health may be impaired by cirrhosis and its complications; neuro-
psychiatric disorders; and nutritional deficiencies. The majority of
accidents, especially the fatal ones, are associated with alcohol, as
are nearly all homicides, assaults, suicides and suicide attempts
among Indians. The vast majority of all arrests, fines and prison
sentences in the Indian population are related to alcohol. The loss
of personal freedom and productivity, the breakup of families, the
hardship and humiliation involved are considerable, although not
easily measured."
Task Force No. 11 has found estimates ranging from 20 percent
to 80 percent of some tribal populations (15 years old and above)
as having drinking problems. Arrest rates for alcohol and drug misuse
are far and above that of the general population. Death rates attribut-
ed to alcohol use are as much as 5.5 times that of the United States
in general. Toxic inhalants which are highly dangerous have been
found to be used by children as young as six years old, in one test group.

C. SUMMARY OF FINDINGS
The Indian people, individually, and through their tribal leadership
and health boards, have identified the destructive use of alcohol
and drugs as the most important and pressing problem which they







* *h(v. 1t has an adverse affect upon all aspects of their health,
,IT 'qaa and economic existence.
d ...government hap sapeaial legal relationship with the
^MIW o n4d has consistently, through Congressional appropria-
1taon, dowledged a responsibility for the health of the Amercan
M d V Alad.. Mn Native. This is evidenced by the comprehensive
MlMWu: y system administered by the Indian Health Service.
S .,. rAm efforts in the Indian alcoholism field did not begin
i 91 ,SEcQomic Opportunity began funding some alcohol-
it tS operated by the tribes and other Indian groups in the
l s$,The passage of the Comprehensive Alcohol Abuse and
7ljhrevention, Treatment, M Rehabilitation Act in 1970
~.0tj National Institutes of Alcoholism and Alcohol Abuse
d Education and Welfare to address the needs of America's
3. i1,b NIAAA funds approximately 153 Indian alcoholism pro-
pft] ^ ~their special project branch. These programs are
V',jlcrtn-p" grants and funding presumably lasts from
~yeas. ,
i kwai Institute on Drug Abuse:(HEW), which was estab-
S3, funds 14 1ndi4n drug treatment- projects through the
Mweore 1hA ttality of unmet need, particularly
01V,!p re ark evek pnwt valid daia base, development
o standards of performance, training of counselors and professionals,
of m.agent capabilities, building of facilities, designing
afpets4 innovative approlwkes, Preventive education, etc.
.H ealt Service conducted a study in 1970 that best
hi difficulty in dealing with alcoholism and drug abuse
pr. issues. "Alcoholism is an exceedingly serious problem
an lrq in. the nation, but virtually nowhere is it getting the
attention it deserves from health workers, not to mention other
pt ad community leaders. Its roots gre many and complex.
c:aj4itsease by sow,; a symptom by others; and apparently
.- a I to ..am. of many different professional and non-professional
pqp Yqt. "~o~frship and the ful cooperation and participation of
4fm'. efqctiM for its effective control. Although health workers
.am b.'t play, perhaps a leading part, alcoholism is no less the
r4 of the clergy, teachers, w enforcement officers, courts,
gio its, social workers iRd perhaps most of all, the com-
muIn itef. Alcoholism is, harmful not only t the physical and
eiW|hp t of individuals, but to family relationships, economic
4 ir .and tke, whole fabric of society. It is a problem that
dww s ..ttack on man jfrant,",
SThe investigations of the Task Force over the past several months
onos sevra ymononts
ltip u~~~lly reinforced this statement. The Task Force has
c 4a statistics aOd reports from federal agencies (NIAAA,
tS~. ,.,^ and otwars), fiw state agencies (the New Mexico
5tByi^tBrol, fqr inance), from the states with high con-
<^t~atinsolw^ peo 4 nd,4-Q; tria a -dother local entities.
Isse rates, e suicides, homicides, arrests
rat!,g .dpwife.dp apd h .abuse, welfare, etc., are all
so exceedingly high that one could almost conclude that the use






of alcohol and drug causes 80 to 90 percent of the problems of hdian
people. Seemingly, if they were not drinking, the incidents would
not occur. This conclusion, while having some validity, unfortunately
does not get at the real issue of what prompts the Indian people to
consume alcohol in this clearly destructive manner.
Alcoholism has been recognized as a treatable disease (a health
problem) and some efforts in the health fields have been made for
treatment and curative methods. However, most of the programI
now in existence for Indian people are structured primarily for the
treatment of alcoholic persons and even then, in most cases, act
only to arrest the progress of his disease temporarily. Thorough
research by the Task Force indicates that while the alcoholic in need
of medical care cannot be neglected, the only long-range approach
to negation of the ill-effects of the extreme high rate of alcohol use
among Indian people is in prevention and provision of alternatives.
This is supported by responses to a Task Force No. 11 question-
naire, wherein tribes, programs, and individuals identified preven-
tion and preventive educational programs as the most needed services.
The second most frequently expressed need was for "returning to
traditional heritage and culture, and utilizing the Indian culture and
treatment programs." The hearings conducted by Task Force No. 11
also indicated a growing interest of many Indian people in joining
the Native American Church which has a strong traditional back-
ground and exerts strong social controls on the use of alcohol and
drugs.
The Task Force therefore recommends that priorities of long-range
strategy be placed upon prevention and emphasis upon traditional heritage
and culture. This strategy must include further research into the identifica-
tion of causative factors, the betterment of education programs, the creations
of training programs, jobs and recreational opportunities which address
the prevention of alcohol-related problems, and the provision of alternatives
to drinking.
Research into causative factors also proved to be a complex task,
with identification of causes including physiological, group drinking
patterns, federal dominance, acculturation, poverty, lack of education,
"feel good," aggression, anxiety and lack of self-esteem. At present,
there is not even a clear-cut working definition of alcoholism. The only
one-hundred percent positive cure for alcoholism, drug addiction or other
substance misuse is total abstinence. There is no other simple way. The
causative factors of both alcohol and drug misuse are varied and com-
plex, with most being more symptomatic of larger and broader
influences such as unemployment, lack of education, poor housing.
Alcoholism is both a social and mental health illness and only
becomes a "medical disease" when the individual is suffering from-
alcohol addiction, cirrhosis, delirium tremors, and other disease
syndromes which are alcohol-related.
In the world of the Indian people, however, circumstances and
forces brought to bear by a non-Indian civilization, culture and
government and the resultant forced-dependence on top of all "normal"
pressures that a citizen is subjected to, have created a compelling push-
pull anxiety wherein alcohol has become a primary coping mechanism.
A successful, long-range strategy to combat the destructive use of
alcohol and drugs would have to be formed with respect to this
premise.







The Task Force has found in its investigations that the total pro-
gram effort by federal, state and local entities falls far short of coping
with the needs of the Indian problem drinker and drug user, with the
existing programs fragmented and of uncertain duration. In order
for the federal government to address the dysfunction of alcohol and
dru misuse to the health and social well-being of the Indian people, the
a Force recommends:
1. Giving the prevention and comprehensive treatment of
alcoholism, alcohol-related problems, and drug-misuse the highest
possible health priority at all levels of federal Indian policy and
programs.
2. The passage of a Joint Resolution by Congress for the pur-
pose of establishing a long-range continuing commitment for
whatever resources are necessary to eliminate this major problem.
3. The development of a distinct national Indian alcohol and
drug abuse entity designed to pull together the multitude of re-
sources, programs, and professional expertise in a coordinated
way. The new entity would need the status commensurate with
thie magnitude of the problem with which it would deal.
A broader discussion of these and other issues and problems, along
with m en specific recommendations will be included in Section II of
this report.
























SECTION 11
ISSUES, PROBLEMS, AND RECOMMENDATIONS IN
INDIAN ALCOHOLISM AND DRUG ABUSE FIELD
A. Federal/State Relationship and Policies
B. The.1ndisn People, Alcohol and Drugs
Ce Scope f the Problem
D. Alcohol and Drug Abuse Program
E, Rwanmended Legislative Actions
F. Other Issues:
1. Community and Social Impact
2. Economic Impact
3. Prevention and Preventive Education
4. Indian Representation
5. ThelLaw, Alcohol, Drugs and the Indian









j' .1
g i . a .5' s ; r >i : *" " ^ 'r I : ; .*

;" .t.i .. *,i .i '^ i f ' ; t .. ..

PROBLEMS AND ,RECOMMENDATIONS IN
W.IN. [A? -ALCOHOLISM AND DRUG ABUSE FIELD
".'.oAf l$.i AFBlitfl/STATU RZLATIONSIUPS AND PoLICIES
mTae Inan people 6 have a direct imique federal/Indian relationship
,llia, !ejng eligible and entitled to the same services, state or
Q 4. :0 .re extended to any,, citizen..
fderl/ndian relationship is a historical one, predicated upon
t j $ lw4 and special federal programs have been established
apiti lover the years specifically to. serve Indian people. The
ttl|^ ,jian..Affa. and" Indiaa Health Service are two such
ii |derAct (25 U.S.C. 13) of 1921 set forth authorities
l9^' ndan Ag,.airs to-expend such moneys for the benefit:
c | uceo., Ir^. .people throughout the. United States for,
IS,. general support, and, Civilization (including educa-
i tie relief of distress and conservation of health.
e Transfer Act of 1955 gvexrecognition to the special health needs
of the Indian people and the Alaska Natives by transferring the
nltWm fltips of the Bureau of Indian Affairs to the Department of
,a bAtiam on and Welfare. The establishment of the Indian
feeltb wvite,op S a separate entity, gaveit a national visibility neces-
rAe ,M with the major health _problems of the Indian people.
AltIouain tbt authorities to serve Lndian people anywhere are set
foth atbISnyder AMt, the scope of: IHS services Was and still is
defined by the annual appropriation process of Congress. The IHS
ptowti pvides services for approximately half of the estimated
tV4la uI Indians in the United States. These services are nor-
ip 0 oided to those Indians living on or near federal Indian
rsmstjps and in traditional Indian country, such as Oklahoma and
Alask.
While the federal responsibility toward the health and general well-
being of the Indian people is wellR-established, the states are not
bound by this historical relationship. The consequences of this dual
.urpi of the Indian p6eople-that with the federal government and
teAtates"-are f-r teaching but generally misunderstood or ignored.
,. ... ,*. i. i 1: ;- .. .: '. . * .. , *
1. PROBLEM
ti r ^ t 1 * :' : 1 1 -* .
Te s.des and somw local governments have long regarded the
Indian people as wardsof the federal government thereby absolving
the state and local government of any responsibility. The Federal
Government, on- the other and, assume that, s citien s ind residents
of the state, the Indian people will be able to tie into the delivery
ssP of thett.lTe assumption have ftaused a multittdd of
w .-.": ;'. : *. \ " .: ^ ]. "" ?. I :, ,, (* ) ^ *I ** .* ,, "
'! "4N hi.. .... .:? r o A ii ..
r'' :') T^ : :. I l ; i s i I 1: .. ; '
".,- ... ,i h :i., ". "* 1'5 > ; i * \ *. *
.14:i r > j ; Eo -U s; ,. Q : -::Q: t : s . I








problems in all fields, as well as in alcoholism, alcohol and drug misuse,
and other health areas:
(a) State allocations for alcoholism monies not given to eligible
Indian programs supposedly because they have supporting
NIAAA funds;
(b) State and local hospitals refusing services to Indian fpbople,
directing them to go to "their own" hospitals, even if this imaans
traveling 100 miles;
(c) Counting of Indian people to qualify for federal block
grant funding, but not using the money specifically for Indian
programs;
(d) An endless list of incidents between state institutions aid
Indian individuals perpetrating a fear by Indians toward ashy
kind of state control.
The federal policy of serving only those Indian people "ron obfr neat"
federal reservations has created a division between the urbann" and
"reservation" Indian. Eligibility is not the issue-all Indians 'ire
eligible. However, this criteria used for provision of services has cadiAed
factionalism among brothers, tribes, and those programs designed tb
serve Indian people. The resulting fight for the "dollar" is destructive,
renders many programs ineffective, and is degrading to the Indiani
people.
2. CONCLUSIONS
There is a federal responsibility and also an expressed authority for
federal agencies to provide services for Indian people. This was'don-
firmed in the Snyder Act and Transfer Act. Health is one of the
services for which Indian people are eligible, and alcoholism, alcohol
and drug misuse are health problems. The Indian people have also
identified alcoholism and alcohol-related incidents as their No. One
health problem.
The Indian people are citizens of the United States and therefore
are eligible for whatever services or benefits any other citizen is eligible
for. The refusal to provide such services on the basis that Indian
people are wards of the federal government and the responsibility
of the federal alone is unlawful.
3. RECOMMENDATIONS
(a) That a revised formal policy be issued reaffirming and clarifying
the federal responsibility and facilitating the implementation of .thon
authorities contained in the Snyder Act which provide for services to
Indian people wherever they may reside.
(b) Every measure must be taken to protect the basic rights of Native
Americans as citizens. States must be cautioned that abrogation of these
rights is unconstitutional and will be dealt with in federal courts.
B. THE INDIAN PEOPLE, ALCOHOL AND DRUGS
There are many reasons why a person uses alcoholic beverages or
drugs. A few of these reasons are "to get high," "to relax," "to forget
my problems," and "have fun with my friends." In a highly complex
industrial society such as the United States, these are common,
understandable, and for the most part, normally acceptable. The
question then becomes: When does the use of alcohol become a





13


problem? Any use of alcohol or drugs which affects or interferes with
a 'E iafth or well-being is a problem. Further discussion only
I 4l[a Wtarying degrees of severity. It progresses from a social
6or"lias to a 'medical disease" when the individual suffers
d lio n or other disease syndromes.
The American Indians and Alaska Natives are some of the most
dn' isolated, and misunderstood people in the United States.
Bford t W advent of the European settlers, the Native Americans
w are ti d4 and culturally secure people and were at peace with them-
salvel the land on which they lived. They were rich in every sense
of the*drd. historically, their causative factors were positive, limiting
alcohol and drug usage (such as peyote) to ceremonies and spiritual
riWt.al I permitted their "spirits to soar," gave them "vision."
EMr, ]oA this controlled usage was not permitted.
The'olling effect of the "civilized society" upon the Indian
people h wreaked da havoc which extends far beyond that of loss of
material possessions. The American Indian and Alaska Native are
cah ti a world wherein they are trying to find out who they are
ani''they are, and where they fit in. The land which was once
teh ij(iWteii," giving them food and clothing, was taken. Their
spidtje. lengths were decried as pagan, and familial ties were
btoktliir own forms of education, i.e., that of legends, how to
liv .W to respect themselves and others, were torn asunder by the
wbiW' tbty's^ reading, writing, and arithmetic. No culture could,
or c expected to be thrust into a world different from its own
and on problems of cultural shock. Also, the Indian people
were given citizenship until 1924. An 1832 federal Indian
law ro'ing the sale of liquor to Indian people remained in effect
u d could have been instrumental in the formation of the
twup," "drink until it's one," and "quick" drinking pat-
terntat Native American people exhibit. The Indian people of
t.... # roud of their heritage and are fighting to maximize its
iP1en eaonf their lives in a dominant white world. Many have
sud ddid Many have not.
'b bflAems of alcohol and drug misuse among Indian people are
muck o ame as in any society, only magnified by the need for self-
identity and freedom from values and controls forced upon them. The
non-Indian society is one they know they must exist with. However,
they want the right to choose whether to join or reject it.
. ia.... case, destructive use of alcohol and drugs among Native
Amq*cai and Alaska Native individuals, families and communities
iaby interwoven into all aspects of their lives and any effort
"'t.:, ieh problem must be comprehensive in scope and with the
lcom ent of the Indian people and that of the federal govern-
m t to support them in any way necessary.
*1. PROBLEMS
S(a) Existing research, as yet, has been unable to successfully put
1*ilism into one specific classification such as physiological, mental,
k wltever, although there are proponent of each. Some research
pjcts have even attempted to prove that Indians genetically
hXA inherited traits which make them susceptible to the ill effects
of alcohol:


77-466--76---








(b) Unless a high priority is put on research on Indian alcohol and
drug use, legislation such as Public Law 94-371, which extends
NIAAA's authority for another three years and carries authorities
for expanded alcohol research, will not allocate sufficient monies to
specific Indian alcohol research projects.
(c) Although the destructive use of alcohol and drugs has been
recognized as a major social health problem, the causitive factors are
varied and complex. In the illness of alcoholism, for instance, the
various stages can be classified as mental, social, behavioral, addictive,
and nutritional. This makes diagnosis and treatment of just this
single alcohol-related disorder alone difficult, at best.
Cd) Years of forced dependence upon the federal government
through the "reservation system", and being treated as second- or
third-class citizens by the rest of society, have built drinking patterns
among Indian people that are highly destructive and will take a con-
centrated and comprehensive effort to alter.
(e) Alcoholism and destructive alcohol use are not the same and
this difference is crucial. Alcoholism is the physical disease. The
treatment or handling of the two are not necessarily the same. Drug
misuse (i.e., marijuana, LSD, heroin, barbituates and others) is illegal.
Past the point of legality, only addiction and disease syndromes are
the "medical disease."
(J) In spite of being recognized a health problem and identified as
the Indian people's highest health priority, alcoholism, as a field and as
the treatment of such, has not reached a level of professional status,
and is treated as an afterthought by most health programs, if at all.
(g) Most of society, although familiar with "the drunk," is ill
equipped to handle those in need of assistance. Also, most medical
facilities neither have detox units, nor are the personnel trained in the
counseling or treatment of the alcoholic or inebriated.
(A) The illegality of drug use and the reluctance of the individual
to admit to having a dependency or making excuses for deviant
behavior while under the influence of either alcohol or drugs makes
the measurement of the precise figure on alcohol and drug misuse an
elusive one. This same denial factor makes it difficult to plan a strat-
egy of prevention before the "crisis" stage is reached.
2. CONCLUSIONS
The American Indian and Alaska Native is caught in a search for
self-identity and a struggle for control of his own destiny. These
frustrations, coupled with lower health levels, higher unemployment,
poor housing, lower education levels, poverty-level income, and
isolated living conditions, have made their society ideal for the
development of destructive alcohol and drug use. Until these under-
lying problems are addressed, the task of changing the drinking and
drug use patterns of the American Indian and Alaska Native is a
monumental one.
There is a continuing need for more research into both positive and
negative factors of problem drinking and drug usage, particularly to
the high destructive patterns of drinking exhibited by the Indian
people. Inherent in this research would be the development of new
and innovative methods of treatment tailored to the needs of the
Indian people.






15


Si. ,.t. 8. RECOMMENDATIONS

') '0a n approa tions b designated for a comprehensive
bAdat'b ra*wfer h study into both the positive factors and negative
0 Itt6:1!" twttve alcohol and drug usage among Indian people.
:4'ht M: a study would, at the same time, make recommendations,
hdt a Ishfr gras roots research, for the development of new and in-
wvtiue methos of treatment which are specifically designed to meet the
heedofthe 'Indien people.
',:: ; ; = -:. = .. ... JB W== ;' ... .. ; =
t*s .h d. #M:.r
.1) *1J i J:r' -: 0. SCooE OF THE PROBLEM
fla^pmohloliu and the destructive use of alcohol and drugs is one
n beIhmbatserious health problems facing the Indian people today,
its fact nw clearly recognized by both the Indian people and the
tal a responsible for their well-being.
"Mmoaseuruet of the extent of the Native American and Alaska
Ntive aeeelism, alcohol and drug usage problem is extremely
.diAi7ukbt'denial syndrome" among alcoholics and the question
Sleglip in other drugs makes the figure elusive, since most of these
iditu"idls oape the statistical sources which would generate a
kltional1 total.
i ting iawvmrces of information on alcohol and other drug usage
are. numerous but of unequal quality and therefore of questionable
value: c^ -
No. .ngd ageqpcy. collects information on all aspects of alcohol and
%gL kijsi (1a70d in. the Indian Health Service Task Force Report
ona Asm .(1970):
Unfortunately, those with the closest contact with Indians are often the least
ie&tf: in their judIgments, while those who set up a rigorous study design
oeamsionally have insufficient knowledge of Indians and their ways. Adding to
l ch.'Ao are Vig'eing definitions of the problem, different patterns of drinking
v9' Om Idn groups.
The Indian Health Service goes on to make a very important
~p~qtwtaisi often overlooked by outside agencies: .. the North
fA un dians are a heterogenous population with a great diversity
ei tr at, attitude and religious persuasions."
MA Waterial and statistics gathered by the Task Force reflect this
j i uniformity. Statistics have been pulled from IHS reports,
individual studies, testimony from individuals, tribes and alcoholism
pit %. Some of the following figures reflect the extent and serverity
^i^^3sb'Swa^' em''^ ^ : iI. i^i Iii i ii : ,
cendar year 1973, on th# twenty-four. federal reservation states
6B.$p.mnt or 399, of the. total Indian and Alaska Native deaths were
WP saMibu t to acoholism, alcoholic psychosis or cirrhosis
*ith alcoholisinm. This number makes the overau mortality rate for
AMths- primarily attributed to alcoholism 51.9 per 100,000, or an
niaep of 23 percent over the rote of 1972. As seen from data over
the past few years, the Indian and Alaska Native suffer a death rate
i .n alcoboliwof 4 to 5s M.pnea that of the United States.-al
jtf e t443tr directly attribute: to alcoholism, 59 percent
f l Ah.M. r O dt1 hpsRwit. aJcohlm 9. percent due to alcohol-
totrfa prstQirfoswlc T e figures do not





16


take into consideration deaths indirectly attributed to alcohol which
include a large portion of accidents.
Of the 1,000 deaths from accidents for 1973, a substantially larg
percentage were due either directly or indirectly to alcoholism or
excessive drinLking. The mortality rate for accidents in fiscal year 1975,
for Indians as compared to the U.S., all races, was 163.2 per 100,00
and 51.7 per 100,000 respectively, again with a large portion
alcohol-related.
Accurate data on the percent of accidents which are alcohol-related
is difficult to obtain largely because many are not recorded as being
directly related to alcohol, but instead, to the immediate cause of
injury or death.
Since very little data exists showing the total extent and patterns
of the Indian and Alaska Native peoples' excessive use of alcohol,
specific populations must be observed. For example, in one central
plains reservation, 70 percent of the population over 15 years of age
reported that they drank. This included 82 percent of the men and
55 percent of the women. When broken down into age-specific group-
ings, 99 percent of the men, age 20 to 29, drink and 72 percent of the
women. In the age group 30 to 39, 93 percent of the men and 85
percent of the women were reported drinking. Drinking, as seei from
data, reaches its peak between the ages of 25 to 44. Percentages of
drinkers varied in different tribes from 73 to 85 percent in men, and
20 to 68 percent in women. ,
In this same community, children were reported as beginning to
drink between the ages of 9 and 17. In the age group of 15 to 19, 60
percent of the boys and 40 percent of the girls reported drinking. Out
of 74 persons over 18 in one small Great Lakes Indian community,
only 7 did not drink or drank moderately.
In Minnesota, where the Indian population is 35,000,40 percent or
14,000 people have a serious problem relating to alcohol.
Boston, which has an Indian population of approximately 3,500,
estimates that from 400 to 800 people are suffering severe incidence
of alcoholism.
Statistics from the National Institute of Mental Health for '1978
show that 75 to 80 percent of all suicides among Indians are alcohol-
related. This rate exceeds that of the general population by two to
three times. The National Center for Health Statistics states that as
of 1972, suicide was one of the three fastest rising causes of death
among Indian people.
In the Ambulatory Patient Care Report for IHS hospitals and
contract facilities for fiscal year 1975, out of 851 suicide attempts
(first visit), 391, or 46 percent, were alcohol-related
The crude death rates of suicide of Indian people on reservations to
United States, all races, in fiscal year 1975 was 21.8 per 100,000 to
12.1 per 100,000 respectively, with a ratio of 1.8. :
The homicide rate for American Indians, although declining over
the last decade, while the national rate has increased, is still three
times the national average.
One of the many other problems indirectly linked with excessive use
of alcohol is that of child and wife abuse. Very few statistics can be
found relating to these problems, mainly due to the fact that they are
not recorded as such in hospital records, but instead are lumped with
other categories such as accidents. If child and wife abuse are recorded





17


s such, again, m)Uii' times they are not linked to alcohol which is
eaj ause of injury.
j.l . ... Patient Care Report for IHS for fiscal year 1975,
,;unjes. number 84 first visits, 32, or 38 percent of
S*oh0lzelated. No such data was available on wife abuse.
ib ieSat rate of alcohol-related crimes range from 7
s hefor Indians than non-Indians. No consistent
Mu J.:.dbe found, although it can be assured the rate is definitely
J^idiw considering population differences.
..a. ike' City, Utah, where Indians make up approximately
Wl : 6ne percent of the population, about 40 percent of the
arr1e public intoxication were Indians. For alcohol-related crimes
. under t 1he influence, liquor law violations and drunkenness)
p ldians comprise 21,069 of the urban arrests and 2,131 of the
exic..o, the Indian population is only 7.1 percent of the
t cet of the juvenile arrests and 19 percent of the adult
a"flndian peoplein 1974.
jrtts on city arrest data, 75 percent of all arrests among
ti fTdhohqrela~ted^ compared to 33 percent among all arrests
i This would make the ratio of Indian to non-Indian
edies' 18 years and younger, city arrest data for 1971 shows
..in.s 25.1 percent of all arrests alcohol-related compared
t~:.t for non-Indians.
iussn arrest rates for juveniles, it is reported in a study
tat more than half of the nation's juvenile delinquents
Stdim families containing alcoholics. This study states that in
app it tly 50 percent of the nation's divorces, which can be a
f IIfactor in delinquency, the use of alcohol was a major
cS-1 separation. It further states that at the present time,
Aar I Ptunated 28 million children affected by parents with
,. as is seen to be on the increase among Indian people,
Pspf youth. In the first quarter of calendar year 1974 the number
C u .cases seen in mental health programs has increased by
'Amos. UOperAt (reported by Indian Health Service).
V.4.ta, there are 8,750 Indian youth from ages 11 to 18
yp sik using abusive chemicals. Sniffing is on the increase and now
W 73 percent of all offenses for American Indian youth in
as compared to 15 percent for non-Indian youth.
y and studies received by the Task Force indicate that
for snidfli purposes and marijuana usage are definitely
S.e, with these two substances being the most common,
iutiv. i'at e fy substances other than alcohol is on the
Hweae ndreatvey n ow 'Abe 108a eol, especally youth,
apa r unavailae, With the recent funding of 14 Native
ibse proams through National Institute on Drug
Se ahi ae needed to and evaluate the
em of qiq~gne djuns should become available within
The data referred to on these pages is expanded into charts and
tables available in the Appendix on Statistical Information.





18


D. ALCOHOL AND DRUG ABUSE PROGRAMS
Although the problem of alcoholism is not a new one, it has only
been in the last seven years that any significant federal effort has been
mounted to deal with it. The first apparent recognition of alcdholism
as a high priority health problem came in October, 1968 when the
Indian Health Service appointed a Task Force to review the extent
of alcoholism on Indian reservations and communities, evaluate
existing programs and resources, and provide guidelines and plans jf
action to assist in meeting the problem. In its report (1970), IHS stated:
It is the policy of the Indian Health Service that services and programs for the
prevention and comprehensive treatment of alcoholism be given ;the highest
possible priority at all levels of administration.
In 1970, the President's message on American Indians further
emphasized the need for program efforts. Monies from the Office of
Economic Opportunity ($1.2 million) and the National Institute of
Mental Health ($750,000) were pledged in an interagency cooperation
and 39 alcoholism projects were funded by OEO and NIMH through
IHS. Subsequently, the National Institute on Alcohol Abuse and
Alcoholism was established pursuant to the Comprehensive Alcohol
Abuse and Alcohol Prevention, Treatment and Rehabilitation Act of
1970. This Act gave NIAAA the sole authority and mechanism for
funding Indian alcoholism funds for six years. On July 26, the Presi-
dent signed into law Public Law 94-371, which extended NIAAA's
authority for another three years. The authorities of NIAAA do not
authorize funds specifically for Indians; in fact, the law, as renewed,
only designated them as an emphasis. As succinctly stated in the
Report of the Committee on Interior and Insular Affairs, United
States Senate, on the Indian Health Care Improvement Act:
The decision to allocate a portion of NIAAA's funds for Indian programs and
to establish an Indian desk within NIAAA to assist in the administration of these
programs was purely discretionary, and therefore, neither constitutes a guarantee
that alcoholism monies will be available for Indians, nor indicates that the federal
government has any responsibility to provide alcoholism programs for Indians.
Additionally, the grants administered through the Special Projects
Branch are considered as "demonstration" or start-up grants, lasting
from three to six years. It can readily be seen that an ongoing alco-
holism priority is difficult to sustain under these conditions.
The National Institute on Drug Abuse, established in September,
1973, currently supports 14 treatment projects in which Indians are
provided assistance. However, here again, NIDA has no specific legis-
lation for Indians and the funding of Indian projects is discretionary.
Other agencies which either have specific legislation for Indian
people (BIA and IHS), or impact upon the delivery of services (DOL,
ONAP, OE, LEAA, HUD), as well as state agencies, often point to
NIAAA as having the lead responsibility. IHS's role is limited to pro-
viding liaison with Indian communities, identifying critical needs and
assisting with technical expertise when interfacing with the health
system. BIA quickly points out that it also does not have any legislative
authorities. The Bureau does recognize that alcohol abuse is a major
socio-economic and health problem among the Native American
population, and therefore established a position (Alcoholism Program
Specialist) essentially to keep the BIA apprised of "what's happening"
in alcoholism.





'19
federal direction in the past decade has been moving toward
d tl ta tion and the funding of block grants to the states, with
r coprnesponding elimination of categorical programs. This direction
h :been dramatically confirmed by the administration's proposal to
fc"..ns:li datelthe NIAAA project and state formula grants programs
,fto' a m inve block grant scheme with the monies going to the states.
Phdeat Ford reaffirmed this position while reluctantly signing
the l tion which extends NIAAA authority for three years. He
mid t the law was "based on a policy of perpetuating the maze
cal federal health programs." He also indicated that his
odiock grant health plan has not been laid to rest and the
signing of the alcoholism renewal legislation was so "that in the
assistance will be provided for these important programs."
aThe'Tsk Force reviewed the state alcoholism plans for those
stes which haii large concentrations of Indian people. Most state
bllhl eftdrts were under the umbrella of the mental health pro-
iatft 'did not appear to receive planning or funding priority.
* l 01i and mental health programs distribute formula
grant funds on the basis of population and not needs. The Indian
or minority" is sometimes identified as a special target group, but
nrlpXh fu&ding priorities in distribution follow. The stated em-
sand plans "sound good" but somehow, the effort is not re-
.. iM local level. Testimonies indicated that if the programs
'depend gpon the states, they could not exist.
Many states feel that the federal government should have total
pfl^t y for the Indian people and that since the Indian programs
epwivisilty (and most of the time, solely) funded by NIAAA, they
do not need to give the Indian programs any funding.
One state issued a memorandum which blatantly stated this
position and the money was held up. A call to the Civil Rights Com-
mission somehow brought a quick reversal. The Indian people his-
toriclly'1&ve fought this battle with the states and their fear of the
adiitration's block grant proposal seems well founded.
... k 4 N i .: y: 4 N .. ..:
v. 1. PROBLEMS
(a) There is no specific authority for Indian alcoholism and drug
abuse programs, only discretionary authorities and funds.
(b) Agencies which have specific authority to provide services
WIndian people are looking to NIAAA which does not provide
() In the game of "who is responsible?," the alcoholic, or problem
alcohol or drug user is the one who suffers and does not receive the
t he needs.
....The sat high priority by both federal and state programs far
kehd the funded priority that actually reaches the programs.
,'J The states count the Indian people for basing their formula
gVit proposal but not for the allocation of funds.
* ) The proas are frliagmented, often duplicated, and suffer from
ScmniurcLation% up an down.
*t~z~ist ograxtis are underfunded.
k):" st o tbef.ede.al grant monies are intended as seed money
o sta noney. After three to six years, the programs are to have
r r ^ .: :[ : ". : ""
*. ... .. : .. ,' .. .





20


identified alternative resources, but unfortunately in the Indian
communities, there are no alternative resources.
(i) Short-term funding and planning make long-range planning,
program, and client commitment difficult. '
(j) The relative newness of the programs and the difficulty i
collecting information on Indian people has created a lack of a re-
liable data base. This makes effective evaluation and application of
standards almost impossible.
(k) The lack of fixed program responsibility has resulted in many
substandard programs as evidenced by lack of accountability to
funding sources, the client, and the community.
(1) Lack of adequately trained personnel at all levels.
(m) The programs are open to both men and women; however, the
treatment and rehabilitation services are geared to men.
(n) Alcoholism and drug abuse programs are normally separate
although certain similarities would make it feasible for combining at
least the prevention, rehabilitation and administration components.

2. CONCLUSIONS
(a) There is a demonstrated need by the Indian people for alcoholism
and drug abuse programs.
(b) The evidence of fragmented federal and state program efforts in
which the clients "fall into the cracks" indicates a needed change in
strategy.
(c) The local alcoholism programs generally lack the funding and
training which is necessary to conduct a comprehensive alcohol or drug
abuse prevention and treatment program.
3. RECOMMENDATIONS
(a) Make the legislative changes necessary to reflect a continuing com-
mitment to combat the problems of alcoholism and the destructive use of
alcohol and drugs among the Indian people.
(b) Strengthen the Indian alcoholism and drug abuse programs by
upgrading their administrative and professional staff capabilities.
set standards of performance;
fix responsibilities;
provide for further training of staff.
(c) Force accountability of the programs to the funding source-dhe
tribe, the community, the clientele-through contract and grant compliance.
E. RECOMMENDED LEGISLATIVE ACTIONS
Section 2 of the Indian Health Care Improvement Act reads: "The
Congress finds that-federal health services to maintain and improve
the health of the Indians are consonant with and required by the federal
government's historical and unique legal relationship with and
resulting responsibility to, the American Indian people" [emphasis
supplied] and further: ". . a major national goal of the United
States is to provide the quantity and quality of health services which
will permit the health status of Indians to be raised to the highest
possible level and to encourage the maximum participation of Indians
m the planning and management of those services."
The testimony, the statistics, the loss of life, health, and dignity
clearly demonstrate the need of the Native Americans and Alaska





21


NbTiv.s.i Trough their tribes, health boards, and individually, they
h Meintikid ^~olholiam and the destructive use of alcohol and drugs
s their number one health problem.
1. CONCLUSION
1 istorr hasshown that short term funding and verbal commitments,
however flitentioned, lead to false hopes and frustrations. Accord-
jwgy, t~. TajF4orce feels that a long range commitment by both the
b4 ifle anad the federal government to combat the adverse
So eoh~ol and drug use is the only way they can be alleviated.
2. RECOMMENDATIONS
(a) Congress demonstrates its commitment to the upgrading of the health
4h el t an eop le andlleviating the adverse effects of alcohol and drug
aW bip ..stWsiwing a Joint Resolution which will:
S(I)et forth a national statement of policy which will acknowledge
its popuMlli.e role and responsibility for all Indian people.
-(2) Provide maximum community involvement at all stages of
laying and implementation in concert with the principles of "self-
letwmination" as set forth in PL 93-638 and the proposed Indian
Eealth Care Improvement Act (S. 522).
S(3) Provide the needed authorities and resources to evaluate the
M1Qngrange gols of the Indian alcoholism and drug programs.
: (4) Develop the criteria, provide the authorities and appropriations
emesa to create a comprehensive national Indian alcoholism pro-
graw 11f program would have as its goal: The reduction of alcohol
nd *w, -use amon all Native Amricans and Alaska Natives everywhere.
SThe program would be designed to interrelate the health care
impcts with other components of a comprehensive alcohol and drug
abuse program and would insure that the development and imple-
mWtkftion of an alcohol and drug abuse program be a joint effort
of ebe alcohol and drug, users, tribe, community and the federal
gwwmeunat.
-No T-A draft of an alcoholism program which is built around a
comprehensive health model is included in the Appendix.
,1ms program entity would have to provide for a broad range of
ps.Wemtion, Iaining, rehabilitation and research. The program would
ave, to be given a separate and equal status, commensurate with the
I tude of this major health problem. It would need the legislative
4tbrity to deal specifically with the problems of the Indian people,
onilnating the broad range of health programs in Indian Health
service ad the social welfare and law enforcement services of the
$0w1 lof Indian Affairs in addition to acting as advocate and liaison
With all oth.: federal agencies which impact Upon Indian alcoholism
laod dir.ga ms M.
i~#)n&STvAk ForOe M.a gwen much consideration ko the appropriate
plme ed l location this program. The Task Force jees strongly
that past efforts in this area from BIA, IHS8 and other agencies has
laomep thel c enaiveneas, scope and initiative necessary to encourage
Sw .f fecftw.tien .t reden and rehabilitation services. An
.*a~ifrstrifonyu **Won of categorical programs and the
proposed 1nJeS (Jar.e ITmprvement Act wouldead us to recom-
mend the most advantageous place in which to locate this program entity





22


would be within the Indian Health Service. A word of caution accom-
panies this recommendation, however. (1) The program must address
the problems of all Indian people; (2) the IHS must work hand in
hand in making its full range of health programs and facilities respon-
sive to the alcohol and drug user and programs.
(c) Provide for the development of a long range (ten to fifteen year) plan
which would involve a coordinated effort of the Executive Branch and the
Office of Management and Budget during appropriations hearings.
(d) Provide for annual Congressional oversight hearings to monitor
the growth and performances of the alcohol and drug abuse programs.
F. OTHER ISSUES
1. COMMUNITY AND SOCIAL IMPACT
The importance of one's environment and the social pressures
brought to bear upon an individual cannot be over emphasized. The
ties of family, friends and community create a bond that is both the
strength of the Indian people and yet many times, the nemesis of the
alcohol and drug user. Too often the community ignores the weak-
nesses and only points to its strengths whether it be the people or eco-
nomic and social successes. Nevertheless, not only does the individual
have a responsibility to the community, but the community has a
responsibility to the individual.
The alcoholic, the problem drinker and drug user affects every as-
pect of community life-welfare, health, family, economy, child
adoption, to name a few. As pointed out in an earlier section, 70 to 80
percent of all suicide attempts, 90 percent of all arrests, 50 percent of
marital difficulties, 38 percent of the cases on child abuse, and most
associated social disorders are done while drinking or using drugs. In-
cidents such as these only create further misunderstandings in the com-
munity as to the needs of the alcoholic, problem drinker, or drug user.
This magnitude of social decay cannot be ignored by the community.
Many times, the first reaction of the community is to ignore its
ills or perhaps to reject them. Then again, the prevalence of destruc-
tive drinking or drug usage in some Indian communities has become
almost socially accepted and a ready excuse for deviant behavior.
The Indian culture is built upon an individual's oneness with him-
self, family, tribe and universe. Economic and social pressures may
disrupt this balance and contribute to the individual becoming a prob-
lem alcohol or drug user. This can occur while the individual is away
from home, whether it is in an urban or rural area, or at home. If the
individual is away and is unable to cope with the disruption of his
universe, the sense of belonging to a community will kindle the desire
to return "home," to familiar grounds and family or friends. Unfor-
tunately, the individual often returns to the same economic and social
pressures which may have perpetrated his problems with the use of
alcohol or drugs. This is also true of the "client" who has just returned
from a treatment center.
(a) Problems
(1) The alcoholic and problem drinker is an acknowledged problem
within the community, but in most cases, the community either does
not want to or does not know how to address the problem.





23


71(2) TheT e is too little effort to educate the community in the prob-
ma o^f tb alcohol and drug user and include it in the planning of
txIol and drug abuse programs.
();'Recommendations
( () TI t planning and implementation of preventive education, strate-
gienasd alcohol and drug abuse programs be built around the community
and ti-Wet entities.
(2) The uding of new, and the strengthening of existing, community
d~~sijp|ertograms requiring that alcoholism and drug abuse strategies
priorities.
S" ^ 2. 19ONOMIC COSTS OF ALCOHOL AND DRUG USE
Thb economic drain upon the individual, family, community, state
and federal entities due to alcoholism, alcohol and drug use is monu-
mfittal. Alcohol World Research, 1975, estimated the total overall
eeddfmic cos6t to the American economy to be $25 billion per year.
fThre has not been a cost/benefit analysis in the Indian communi-
ties; however, a recent study by NIAAA on alcoholism treatment
pentes would give an indication of the enormity of the cost. NIAAA
tried t assess the impact of the treatment programs from three
viewpoints: that of the national economy, community economy, and
that of the individual client. Specific benefits spotlighted were re-
dueed hospitalization, increased earnings, decreased motor vehicle
accidents and decreased criminality.
9Thgreults of the study indicated that for every dollar expended in
tWi6,am the national economy realized a return of $2.96. The
fiL pty would benefit $11.46 for every dollar spent. (It was pointed
out that' 1he higher figure for the community was based on the fact that
the $ederal government paid for a major portion of the program.)
The cost benefit ratio for the individual client's economy was $6.21
for every dollar spent.
.In.l. iian communities, the additional weight of the alcohol and
dftg uref only compound already severe economic woes.
" !. : ^ , :
^^Cencus ions
SEven though there has not been a cost/benefit study done on the
Indian alcoholism programs, a projection from the study by NIAAA
of AMT.C.'s would support a further conclusion that the benefits of
alcoholism and drug abuse treatment programs far outweigh the
stes to the national economy, the community, and the individual.
Cutjio must be exercised, however, in relying solely on monetary
Values to measure benefits. It is difficult to measure the worth of
seaVga one's life, the preventing of & child from being taken from his
fsnily, or the restoration of one's dignity.
() Reommendation
That cost/benefit analysis be used to emphasis the added benefits in the
Prention of alcoholiA, and the destructive use of alcohol and drugs.
P. RflVRW2XON AND PUBVhNTIVY EDUCATION
Many of the Indian alcoholism programs have indicated in their
testimony at Tas Force ..#11 hearings such things as: they were





24


pressured by their tribes to "show results"; "they couldn't be very
effective . look at all the drunks at the jail or on the street";
"most federal grant programs concentrate on the treatment aspects
of alcoholism programs in their funding priorities"; "the individual
rarely admits to having a drinking problem or to being addicted to
drugs until he reaches the crisis stage."
The above comments and situations depict typical attitudes and
situations that prevail in the field of alcoholism and drug abuse today.
The social concept of having a drink of two with friends is an old one
among the non-Indian society and one that continues to be a part of
the life of the "typical" American. In contrast, the "obnoxious drunk"
who becomes loud and boisterous, or "passes out" from too much
liquor and the alcoholic who cannot control his drinking and becomes
wracked with delirium tremors ("DT's" or the "shakes") becomes a
social outcast to be avoided.
On the other hand, the Indian cultures, historically, have had
difficulty in developing strong social controls for the usage of alcohol
when not used in a spiritual context. The development of usage
patterns was based on the propensity of the alcohol or drug to trans-
port the individual into a world different from the one that he lived
in. Prior to the arrival of the Europeans, the use of crude wines and
drugs such as peyote were used primarily in ceremonies or religious
rituals.
Subsequently, forced removal from traditional lands, restrictions to
federal reservations and other subjugations to the "white civilized
society" created different inducements to drink-to forget, to release
inhibitions and vent angers, to dull pain and to avoid the necessity
to face a world which no longer was theirs or that they could control.
For the most part, the Indian cultures, while not condoning it,
did not attempt to socially control this form of drinking. The person
was not in control of his actions and thus could not be blamed for
deviant behavior and was tolerated.
Any form of prevention, or the development of preventive educa-
tion, will have to do far more than show films on what sustained usage
of alcohol does to the liver or what the drug addict goes through in
withdrawals. Attitudes and patterns of living will have to be altered
in order to ultimately result in a reduction of incidence. The commu-
nity, which can and should bring tremendous pressure upon the indi-
viduals which live in it, cannot either ignore its ills or expect the
alcoholism programs to come out each morning and sweep the streets,
clean the bars and jails of their drunks, take them to their detox or
treatment center, dry them out and expect them to come forth the
following day, shiny-faced and full of bright expectations. It will not
happen! The real shame is that both the white society and the Indian
communities intuitively know that crisis-oriented programs are
doomed to failure in the long run. As stated in the Report on the Indian
Health Care Improvement Act (S. 522, May 13, 1976), underlying
social, economic and cultural causes of alcoholism make it an extremely
difficult health problem to remedy, particularly when it competes for
scarce health care resources with the numerous other health problems,
many of which respond better, more quickly and with less expenditure
of funds. The report could also have added "more easily seen."
The Indian child who is born and raised in an environment of
drinking, broken homes, or sent to Government boarding schools
far away from home, already has a higher probability of ending up





25


wiS"U i gU g prdblemj dead, orin jail. Add to this the many other
ide a~vVwich exert pressures upon him. The self-image quest
thateach must go through is a difficult one. The "old way" clearly
defined the roles of the warrior, the hunter, and the woman; they
oplrhad pove themselves. Today, the youth must look to what is
a 'Y7 h direction. Fbr .instance, most of what he sees in and
oh niedim a is news of robberies and killings. Say for instance
0 0He turns 'on the T.V. and what does he see? The
S& t-hat is projected by such television commercials as
$!! acting ^favorite sports figures spending fun-filled
Si te local taverns drinking "Lite" beer. This cannot be
CRAM : t a a0od'influence.
fTAe future sts, in the young people, but it is the responsibility
tit d "elders of the community to shape their attitudes.
'irt mu assist them in finding alternatives to drinking
.f . The ask Force found it encouraging to receive indications from
testimony and studies that there appeared to be a growing interest
41e;'ovewat amongthe young people back to the "old ways",
alyAw t ste.gtjrtn. :of the Indian culture. An example of this
nw m t: ntis. tlhgrowth of the Native American Church. Not only
does it advocate a complete spiritual peace with oneself and the
bas- Aw.hbuti the Native American Church exerts strong social
controls upon one's actions. While peyote is used in ceremonies such
Sss ',...tao heighten' the spiritual experience, both the use of
pepchiba4* Woutside of the ceremonies is restricted.
(a) Prblems
(1) The majority of alcoholism and drug programs concentrate
oQaZpp 4i ter the individual already has a problem.
^ treatments are primarily detox and counseling. While
SA~~0 aY, kthe individual must return to the same situation,
.,n4envir~~xant which caused him to drink in the first place
... ...ty. attitudes toward the individual with a drinking
.se proven are permissive in nature.
.f et. jgeneal lack of knowledge by both the individual
lLc~~m< ui^ tbbout alcohol and drug usage. This is in spite of
Sbigly visible death, morbidity, suicide and homicide rates, not
..o.. the, arrest rates, broken homes and child abuse which can
uted to problem drinking and drug use.
sot bebaviorgl patterns are learned ad can. be classified as
... jgjiu nature. Cbfildren learn from teir environment both
l. ~rem o4. f the children, to foster homes or sending them
, gponnntboh sg 8s401 many times fosters anxietie
whIh are conducive to dnking pr using drugs. Most of the-federal.
4 g" ohave be n critic ized as compounding drinking and
ti ,a problems. :
(7) Many communities do hot now have or have attempted to
provide alternatives to drinking and drug use. Examples would be:.
pGgpall!r: p mtie molv ent in. .ommumnity projects,
cultai^hoimi.pvogram sid wmd.k progam.
SI Thdtdefittioa or concentt~o prevention is too narrow.






26


(9) Although the majority of people with alcohol and drug problems
are men, the increasing incidence among women and youth is often
ignored.
(b) Conclusions
(1) Most existing programs are primarily crisis-oriented treatment
centers, and a far more effective use of limited resources would be to
put at least as much emphasis on prevention in the community and the
development of preventive educational materials for Indian youth.
(2) A prevention program which does not begin at the community
level is not comprehensive in nature, and does not build its strategy
upon the changing of behavioral patterns and those factors which
influence them, and will ultimately fail.
(3) The growing movement of the Indian people toward the "old
way" indicates a need for self-image. The building of preventive stra-
tegies must emphasize such values as exhibited by the Native American
Church.
(c) Recommendations
(1) Give the building of a comprehensive prevention and preventive
education strategy a high priority, stressing the community leadership
and involvement in changing behavior patterns and development of alter-
natives to drinking and drug usage.
(2) Build prevention strategies emphasizing the strengths of the Indian
culture.
(3) Build strategies, programs, and formulate preventive education on
emphasizing women and youth as well as men. Build upon familial and
community ties.
4. INDIAN REPRESENTATION
The concept of Indian self-determination centers around the recog-
nized need for Indian involvement, from the beginning planning stages
to the eventual management of their own programs. This is particu-
larly true of the Indian alcoholism and drug abuse field. Conventional
programs are designed to serve the general population and do not take
into account the unique cultural needs of the Native American and
Alaska Native. Too often this results in the prevention of Indian
people from participating in and benefitting by many otherwise
successful program resources.
Existing Indian input into federal and state programs is through
local advisory boards, state or regional commissions, elective national
organizations (National Indian Board on Federal Agencies), tribal
health arms and other Indian organizations which are federally or
state funded under contracts or grants (American Indian Commission
on Alcoholism and Drug Abuse and National Indian Health Board).
These are both effective and ineffective, depending upon whether
the limitations of such bodies are recognized.
There is a continuing need for "Indian input" in the planning and
administration of the Indian programs.
(a) Problems
(1) Programs which do not have Indian people involved in the
planning stages as well as the administration are usually formulated
on non-Indian criteria and standards and in ignorance of cultural
differences and needs.





27


.(.) bFdwral and state agencies often make policy decisions on non-
tIaa popsrm which may still impact heavily upon the Indian
/ 0) TWak Force No. 11 in its hearings and on-site visits found
Voied coer that representative organizations do not represent
thi iuteret and were: (1) politically chosen; (2) always traveling;
() gave them feedback; and (4) were not accountable.
f a 4 JA4viory bodies often complain that their advice is not taken
lederal and state agencies.
(8) Man federal and state agencies feel that the advisory bodies
jit: k m and get into areas that are not germaine to their
Otwv
(1) Cobd*ins.
9(1) Thpre are over 250 major Indian tribes in the United States
and many ore Indian communities. It must be recognized that each
hs its ow individual needs based on its community, culture, and
,ptl location. No single organization can hope to represent all
( A2) Mnyof the problems involved in the solicitation, submission
and sW "Idian input" arise from the unclear delineation of
rebiitiee which are given to the advisory bodies. If their duties
d: and limitations are not clearly explained in their charters,
rf confused not only of what they can or cannot do, but will
beidtim iiered if their recommendations are not taken.
(4 Rqcompadation
(1): That "Indian input" must continue to be solicited and used in the
formation of legislation, policies, and programs which impact upon
(2) Jdera and state age e look to accepted community leaderships
nl and participation with reect to alcoholifn and drug
abuse programs. The reservation-based prograaw cannot exist without
inol and support of their tribal leadership.
(3) Preentative Indian bodies under contracts or grants must be
Sb for actions and funds to their constituency and to the
(4'ee.ral and state agencies clearly delineate authorities, responsi-
hiten and limitations in their contract or grant agreements with repre-
sentatitve Indian bodies.
5. THE LAW, ALCOHOL, DRUGS AND THE INDIAN
The legal systems of the United States are established for the
protection of community and individual rights. The Indian people
fall within the jurisdiction of several legal systems-federal state,
lool and tribal-and this network of systems has not always proven
resonsive to the needs of the problem drinker or drug user.
Ile use of drugs and the traffic of same is still illegal and therefore
a criminal offense of varying degrees in nearly all areas. This makes
the reponsibilities of the law enforcement agencies slightly different
tan when handlg the alcohol user.
Since it is not to consume alcohol (if of legal drinking age),
the alcoholic or alcohol user theoretically does not come within the
legal system unless he has committed some act which endangers the






28

well-being of others, himself, violated a civil statute or has committed
a criminal offense. This, many times, permits the law enforcement
official and courts "open season" on the alcoholic or anyone using
alcohol who has angered them. The Task Force has received testimony
citing cases of police brutality of not only the alcoholic or person under
the influence, but gross mistreatment of the individual for just being
"Indian." It is interesting to note in this context that the Utah
State Director of Indian Affairs states: "Approximately 41 percent of
all arrests in Salt Lake City for public intoxication are Indian people
and we comprise only about % of one percent of the population."
Not all Indian law enforcement relationships are negative, however,
legal authority makes it convenient to mistreat the alcoholic or alcohol
user rather than attempt to help him. Aside from simple intoxication
or public drunkenness, criminal offenses, accidents, suicides, child
abuse, and other marital disorders also bring the legal systems into
close contact with the Indian alcoholic or alcohol and drug user.
It has been estimated that 90 percent of all arrests of Indian people
are alcohol or drug related. Many state and federal prisons have
substantial numbers of Indian prisoners.
Recent decriminalization in many states has greatly reduced the
cases of Indian people being arrested for simple intoxication.
Also, the tremendously high law enforcement costs of drug preven-
tion have now raised the issue of legalization of marijuana. Although
the research studies have not conclusively proven marijuana habit
forming or harmful to your health, the use of "grass" or "pot" seems
to be following much the same legal patterns as did alcohol during
prohibition days. "If you can't stop it, legalize it, tax it, and try to
control it!"
The Task Force has found in testimony and also field studies
such as a survey done of the students at Fort Sill Indian School in
Oklahoma that there is an increasing use of marijuana and other
drugs among Indian people.
(a) Conclusions
(1) Treatment by arrest satisfies the legal situation but is punitive
in nature and does not contribute to the helping of the individual
(2) If an estimated 90 percent of Indian arrests are alcohol or
drug related, it would appear that the relationship of the legal systems,
community, and Indian individual need further study.
(3) Legal systems (including law officers, jails, prisons, courts,
probation officers) are uniquely suited to contribute to the preven-
tion, treatment and rehabilitation of the alcoholic and the problem
alcohol or drug user.
(b) Recommendations
(1) Require that responsible agencies such as the Bureau of Indian
Affairs set up programs with the federal, state and local law enforcement
officials which woild: (a) Provide jor the referral oj the "simply inebriated"
to a detox center or Indian cultural center; (b) Ij a person has committed a
lesser criminal offense, require the Indian offender to participate in an
alcoholism or drug treatment program; (c) set up Indian alcoholism and
drug abuse programs within federal and state prisons.
(2) Initiate a Congressional study into the possibility and ramifca-
tions of legalizing marijuana.














In 4



: .... SECTION III
APPENDICES

A., Tb Snyder Act of 1921
B.. Historical Information
C. Excerpt From the Report of the Indian Health Service Task Force
on Alcoholism, 1970
D. Dru:g Usage Summary
. Summary of Letters Received by Individuals, Programs, and
Tribal Representatives in Response to Questionnaire
F. Statistical Information
G. Program Description of Federal, State, and Local Agencies
IL An Alcoholism Program Built Around a Comprehensive Health
Model
I. Veterans' Administration Study on the Feasibility of Combined
Alcohol and Drug Treatment Program
J. Unrpts from "The Alcoholism Report"
K., ERAiats From Report of the Committee on Interior and Insular
Aflure, United States Senate
14 Summary of Task Force Hearings





i : *:"

E :: .E


77-466-46-4















S.... A. SNYDER ACT OF 1921
2-5.C. X10 EXPENDITURE Of APPROPRIATIONS BY BUREAU OF INDIAN AFFAIRS
The Bureau of Indian Affairs, under the supervision of the Secretary of the
Interior, shall direct, supervise, and expend such moneys as Congress may from
time to time appropriate for the benefit, care, and assistance of the Indians
throughout the United States for the following purposes:
General support and civilization, including education.
SFor relief of distressed and conservation of health.
For industrial assistance and advancement and general administration of
Indian property.
For ertn, improvement, operation, and maintenance of existing Indian
irrigation systems, and for development of water supplies.
For the enlargmenet, extension, improvement, and repairs of the buildings and
grounds of existing plants and projects.
For tM employment of inspectors, supervisors, superintendents, clerks, field
matros, farmers, physicians, Indian police, Indian judges, and other employees.
For the suppression of traffic in intoxicating liquor and deleterious drugs.
For the purchase of horse-drawn and motor-propelled passenger-carrying
vehicles for official use.
And for the general and incidental expenses in connection with the adminis-
tration of lndian affairs.
(November 2, 1921, c. 115,42 Stat. 208)
B. HISTORICAL INFORMATION
The native people of North America (with the exception of a few tribes) before
the coming of European settlers to the New World in the 15th and 16th centuries,
were unacquainted with liquor in any form. The first Native Americans to come
in act with the substance were obviously those along the eastern seaboard,
with the peoples further inland not experiencing contact until the 17th, 18th
aM even 19th centuries in the western-most regions.
Tribes such as the Pimas, Papagos, Apache and Havasupai, located along what
is now the Mexican border and somewhat to the north, were known to have a crude
form of liquor used for religious ceremonies. Papagos used their crude form of
iquor, cactus fruit wine, in a ceremonial context particularly to produce rain.
These tribes and many in the same area, also came into early contact with Spanish
explorers but there is no documented evidence available to show any ill effects
in regards to alcohol use from this period. This was to occur later in their history
from westward expansion of European settlers. .
The initial avenue of contact of liquor to the Native Americans was to come
from the fur trappers and traders moving westward in search of more game. At
rst used as a gesture of friendship or article of trade, the sharing of liquor soon
degenerated into a powerful weapon which white entrepreneurs used to their
ditiet, advantage and the Indians' disadvantage. Trading for the most part was
preceded by drinking sessions after which the intoxicated Indians "blithely traded
awAy valuable possessions to maintain their inebriated glow. Most of the respect-
able traders disourged the use of alcohol as regular payment for furs, largely
because drinking obviously lowered productivity but partly because they could
ee all too clearly how disruptive it could be in a society with no traditional means
of coping with It."
SIt is from these traders, trappers and later miners and cowboys out of the
western frontier that Indians formed a style of drinking. Because of having no
contactt with the substance before the invasion of the whites, they had no norms
by which to regulate drinking sociably. They also had no one but these traders,
trappers and other frontiersmen as examples upon which to base their drinking
patterns. As stated in the article "Drinking on the American Frontier," these
American pioneers di"negarded learned social sanctions for drinking in an untamed
land. Their reliance on whiskey was in direct proportion to the hostilities en-
countered on the frontier. The Indians developed a kind of emotional dependence
(31)






32

on alcohol. "Like other westerners, they found that their world seemed more
attractive when viewed under the influence of firewater."
Liquor was also given as a form of payment for services rendered. Military aid
given by the Indians to both the British and French was paid for by quantities of
liquor. Scouts enlisted by westward expeditions and later American military
forces were reimbursed with "firewater."
Even the Indian Whiskey itself ". . was a vile potion that was usually
drugged and diluted to best serve devious ends." Drugs such as strychnine and
laudanum were added and justified on the grounds that aggression would be
diminished. But this was not to be the case, as aggressive acts came to be the
outcome of heavy drinking bouts. Men, women and even children drank huge
quantities rapidly with the sole purpose of becoming totally inebriated. Other
characteristic drinking patterns included:
No solitary drinking;
Food and alcohol were never mixed;
Drinking until the supply was exhausted or until the drinkers passed out;
The sharing of beverages if in short supply;
Breaches of Indian codes of good conduct excused while under the influence;
Development of a high cultural expectancy for the value and effects of
alcohol; and
A marked release of hostilities.
It is from this last characteristic of drinking-a marked release of hostilities-
which served to reinforce the white man's view of the savage Indian who they
thought, due to physiological differences, transformed upon drinking from stoical,
reserved, circumspect behavior to that which was erratic, destructive and
terrifying.
In the far north, the initiation into the use of alcohol came from the whalers
and traders who dealt with the Alaskan Natives. Starvation was sometimes the
result, as "a whole fishing or hunting season might be dissipated in drunkenness."
Indians, themselves, were not unaware of the destructive use of alcohol in their
culture. As early as the 17th century, plcas from Indians to traders and others
concerning the liquor traffic were heard, but in vain. Early Indian religious
prophets such as Handsome Lake (Seneca), and Wewoka (Paiute), as well as
Nativistic movements, including the Ghost Dance religion and the Native
American Church condemned drinking as the most evil and damaging introduc-.
tion by the white men. In these specific movements, the Indians sought a solution
to the destructive use of alcohol. They also were to seek aid from the federal
government.
As early as 1802, a verbal plea was made to President Thomas Jefferson from'
Chief Little Turtle to regulate the sale and traffic of intoxicants into Indian
country. This plea culminated in the Act of March 30, 1802 (Sec. 21, Stat. 139)
"to take such measures, from time to time, as to him may appear expedient to
prevent or restrain the vending or distribution of spirituous liquors among all or
any of said Indian tribes," but this Act alone did not suffice to effect general
prohibition. This prohibition came about gradually with the passing of the Indian
Intercourse Act of July 9, 1832, which made it illegal to sell liquor to Indiana
anywhere in the United States. "By 1844, traders were not allowed to enter
Indian camps. By 1850, most American Indian tribes had become sufficiently
disorganized in terms of social, political and religious organizations, and of values
and beliefs, to arrest the attention of health and welfare groups".
A more comprehensive system of prohibitions and enforcement measures.
evolved gradually, culminating in the Act of July 23, 1892 (27 Stat. 260); as,
amended in the Act of July 15, 1938 (52 Stat. 696), which was in effect until 1953.
Under conditions of the law, any disposition of intoxicants to Indian country was
made a federal offense punishable by imprisonment and heavy fines.
Many tribes forcefully relocated to reservations after defeats in war during
the 1860's, and those tribes already living on those specified tracts of land, came
under the control of both Indian agency superintendents and military commanders,
some of whom "issued spirits to the Indians as part of their regular rations." The
reservation, although encased by specific boundaries, was still so vast and thinly
populated that bootleggers and smugglers of liquor and other articles were never
effectively controlled by the available enforcement officers and therefore left to
flourish.
Prohibition for Indians was to continue past the repeal of the 18th Amendment
in 1933 even though they were granted full citizenship in 1924. The bootlegger and
smuggler continued to peddle their intoxicating wares at great expense to the
Indian people, both financially and legally. It is from this prohibition era in






33


l--ehis-Ntey that many of both the patterns of drinking and causative factors
hfht dnkiAg nn be -seen emerging. Gulp drinking and rapid ingestion of
Sluhe s pef.ioular drinking patterns of the American Indian, are said to evolve
stemy r this eraL The very illegality of the drink "may have in fact increased
it appel, especially for the adolescents and young adults."
.kthepst.-repei eras after 1953,, a few tribal councils decided to continue the
mrohibitia ~f. liquor on certain reservations, or to strictly regulate its sale. On
sumn the law remains in effect until the present day. It is thought by some that
this discriminatory, though well meaning, prohibition of liquor to Indian tribes
for ome 120 years only made the problem of alcoholism among Indians even more
Inmoae recent history, programs for the Native American alcohol abuser have
become available through funds from the Office of Economic Opportunity in the
late 16W. President Nixon recognized the magnitude of the problem in his
IU July 8, 1970, when he added additional funds from the National
eof Mental Health to Indian projects. Later that same year, the National
I ate a Alcohol Abuse and Alcoholism (NIAAA) in compliance with the
Oo{rebmemuI&va Alcohol Abuse and Alcohol Prevention, Treatment and Rehabilita-
tio Atof 1970, "'wa established to coordinate all federal activities in the
al in s field to administer all DHEW alcohol programs and to develop project
grants and contracts for the alcohol programs."
Native Americans, their problems with alcohol, and their programs received
priority emphasis in June, 1972, at which time funds from the Office of Economic
Opportity were no longer available. The continuation and support of these
pn t was then assumed by NIAAA, which Is currently supporting 151 Native
Americam Programs (as of fiscal year 1976). The annual operating level of these
Dram U N15.6 million: $3.6 million for the 52 urban projects and $12.0 million
to rem vation project. There are also 12 NIAAA funded Indian alcoholism
fB og e at a cost of $1.6 million, which brings the annual cost of all the
tedwl .... to Indian alcohol programs to $17.2 million.
It e to drug use (excluding alcohol) there is no conclusive evidence of
destructive use of such substances until approximately the last decade. Certain
In f..lps "h*ad experimented with the hallucinatory properties of the cactus
sad ti'j lts" before the coming of the white man. Over the past centuries,
peyote been used in various nativistic movements but largely only in a religious
eo 1t10 It is only in recent history and present day that there exists a problem of
destructive use of drugs among Indians, particularly Indian youth. This abuse
tody Includes primarily the sniffing phenomenon: glue, gasoline, and other toxic
There ae currently 14 Native American substance abuse treatment, prevention
ndl rhabilitation programs funded through the National Institute on Drug

C. Kof2fl FROM THn REPORT OF Tm INDIAN HEALTH SnBVICI TASK Foncz
i ON ALCOHOLuSM-1970- -
T E E P.AT'ERNS AND EXTENT OF INDIAN DRINKING
Im one central plains reservation, 70 percent of the population over 15 years of
pepe Poted that they drank. This number included 82 percent of the men and 55
pont f the women. In the age group 20 to 29, 99 percent of the men and 72
pqaet of the women were drinkers, whereas in the age group 30 to 39, the figures
floS 3 percent and 85 percent respectively. After age forty, there was marked
dh i in the percentage of women drinking and a smaller decline for the men.
Iie 15 to 17 age group 50 percent reported drinking: 60 percent of the boys
a" 40 percent of the girls. Drinking began between the ages of 9 and I 7 with an
rage of 15 and one-half; of those under 17, 88 percent reported th&t most of
ab friends drank. In this study, 31 percent of the total sample were abstainers;
45 percent drank less often than 3 times a week; and 24 percent drank three or
mne times a week. Evidence was presented to show that both sexes, but especially
th women, wer drinking more in this generation than iu the last.
In a small Great Lake Indian community, only seven out of 74 persons over 18
6=nd be olasesified as non-drinkers or moderate drinkers. Most youths began drink-
g between the age of 14to 16.
" .i study of high school stu dents in a plains tribe, 84 percent of the boys and
76peroent of the girls aimed tkey drank. Thirty.seven percent claimed they drank
frequently. .,..'. : :: .. .. ...:






34


Among southwestern Indians hospitalized for various reasons, 78 percent ef
men and 48 percent of women described themselves as drinkers. Two-thirds of
these men and one-half of the women considered themselves "heavy drinkers,"
with a percentage of 86 percent in the men and from 20 percent to 68 percent in the
women.
In a study of an Indian village in the southwest prior to repeal of the liquor
laws, 105 out of 614 adults were observed to be regular drinkers and about hall
were estimated to be at least occasional drinkers. The male to female ratio was
3 to 1. After repeal, the pattern did not change noticeably.
Although it is unsafe to generalize, what few studies have been done on
drinking patterns in Indians have a certain consistency. Drinking is widespread,
reaching its peak of frequency in the age groups 25 to 44. Males usually outnumber
females by a ratio of at least 3 to 1. By the age of 15, most youths of both sexes
have tried alcohol and some are drinking regularly. After the age of 40, there is a
noticeable decline in the number of drinkers and the extent of drinking. Many
Indians of all ages are total abstainers.
For the most part, drinking occurs in peer groups or extended family groups.
Alcoholic beverages, most often beer and wine, are freely shared within the group.
Drinking usually is associated with happy or festive occasions, such as weekend
social events, pay-day, pow-wows, or the end of a work season. Intoxication is a
common but by no means inevitable outcome of these episodes.
Alcoholism and its effect.
The adverse effects of excessive alcohol use may be approached through an
examination of general mortality. and hospitalization statistics, special studies,
and welfare, court and police records.
In calendar year 1967, there were 183 Indian deaths primarily attributed to
alcoholism, alcoholic psychosis, or cirrhosis with alcoholism in the 24 federal
reservation states, for an overall mortality rate of 33.1/100,000. These deaths made
up 3.8 percent of all Indian and Alaska Native deaths that year. A substantial
but unknown percentage of the 1,000 other Indian deaths from accidents were due
directly or indirectly to the problem of excessive drinking.
In a lower plateau tribe, there were 56 deaths directly associated with drinking
and five others indirectly associated with drinking in a population of 1,581 in an
11-year period. Of the 61 deaths, 47 were males and 14 were females. The cause of
death included: 12 suicides, 12 over-consumption of alcohol, 11 auto accidents, 8
other accidents, 6 murders and 12 miscellaneous.
On the same reservation, the Service Unit Director states that 38 percent of all
hospital days for 1967 were attributed to the use of alcohol.
In a northern plains community of 3,500, there have been 42 deaths attributed
to excessive drinking in a 4 year period. Ten of these were homicides and another
six were suicides.
A study of adult Indian autopsies in the southwest showed an incidence of
fatty, nutritional cirrhosis of 12.8 percent, about four times the national average.
This condition may be related, though not necessarily, to excessive drinking.
In an Indian community of 2,300 persons in the northwest, a register of ac-
cidents and their relation to drinking was kept in fiscal year 1968. Forty-five out
of 56 auto accident injuries, 56 out of 181 other accidental injuries, 30 out of 32
fights involving injury and all 35 suicide attempts were related to drinking. These
figures were felt by the IHS staff to be conservative. In a study of suicide in a
southwestern Indian tribe, 47 percent of cases involved intoxication at the time
of or just before the act.
Since deaths must ultimately be assigned to only a single cause, many a victim
of chronic alcoholism or acute intoxication is listed as a death from accident,
suicide, homicide, bronchopneumonia, or a host of other causes. Hospitalization
data have many of the same limitations, especially if only the primary or im-
mediate cause of hospitalization is considered. Many hospitals, in fact, will not
admit a patient suffering from the effects of alcohol unless there is another justi-
fication for admission as well. Diagnostic fashions are another source of confusion
in this area. Hospitalization rates will be affected by the beds available, local
hospital policy, recognition of the relative importance of alcoholism as a health
problem and the attitudes of the local people toward their hospital.
For the period July 1, 1967 through June 30, 1968, there were 1,415 discharges
from all Indian Health Service and contract hospitals with the primary diagnosis
of simple alcohol intoxication and another 1,372 discharges for the various other
forms of alcoholism. These totals account for 1.7 percent and 1.6 percent re-
spectively of the total discharges from these hospitals. For the Indian Health






85
:N olpitals In the Window Rock, Phoenix, Aberdeen and Billings areas in
a pImdbu4ly 1, 1968 through December 31, 1968 when more detailed informa-
t ior .a~Vaaleismple intoxication was listed as one diagnosis on 3.2 percent
of all and other forms of alcoholism on another 1.3 percent. For males
ftlj if"o1 where the problem of alcoholism is primarily concentrated, these
Become 12.4 percent and 5.0 percent respectively. The overall sex ratio
( for fdit charges for which simple intoxication was listed as 2.51/1.00. For
l "bth alcoholism, the sex ratio was 0.87/1.00 and for delirium tremens
"We records of the local police, courts and prisons provide one of the most
tedn and graphic sources of information on the extent and impact of alcohol
problems ins population. In many Indian communities, they are often the only
O,*e whih have been explored. In interpreting such information, however, a
*LAMf ftution is necessary. Police and courts, whether tribal, municipal, county
state or federal, are inclined to deal more harshly with Indians who are found
In#uecated than they would with non-Indians. An Indian usually runs a far
I 'iSte k of being arrested and locked up for drunkenness than a non-Indian
would unde' similar circumstances. Arrest and conviction figures for Indians,
thrtore re somewhat inflated when compared with those of the general
p i.'Even when these allowances are made, however, the figures are still
IMandreaN testimony not only to the extent of drinking, but to the social and
'fta!y 1IWption, the loss of productiveness, the loss of self-respect, and the
alHd s ad illM health caused by the excessive use of alcohol.
The fguie. that follow are chosen to be fairly representative of a considerable
%0ss of tvilable information:
la l190, Indians were arrested 12.2 times as frequently for alcohol-related
oenAe a the U.S. population generally. Whereas 43 percent of all arrests in the
18. weft:: Mated to drinking, the comparable figure for Indians was 76 percent.
Drunkenness alone accounted for 71 percent of all Indian arrests. The arrest rate
fo tidnilobol-related offenses was found to be only slightly above the U.S.
tflersge."* *: .*
17r a ceOW plaiW reservation, there were in one year 2,585 arrests for "dis-
orderly cduet with drunkenness"' in a population of 4,600 adults.
elk- 4 ihree-year period, 44 percent of males and 21 percent of females had
benrsw d at least once for a drinking-connected offense. Of these, % had been
tested more than once and >o more than 10 times. Of all juvenile offenders (under
IS d* arter had been booked at least once for disorderly conduct or a drunken
drlnclg.V Thirteen percent of the entire population aged 15 to 17 had been
U e at least once on a charge related to drinking.
lthie southwest, a reservation reported that 70 percent of crimes on the reserva-
W'binmu alcohol-related. In an off-reservation town nearby, there were 750
ar month for drunkenness, 90 percent of which were Indians.
I one state penitentiary, Indians made up 34 percent of the inmates whereas
Aim theatre they comprised only 5 percent of the population. A large majority
tt' crimes were committee while under the influence of alcohol. In 1959, all
36 Indian prisoners at a federal prison had been convicted of murder or manslaugh-
tet which had occurred while the individual was intoxicated.
J OtOn & northern plains reservation with a total population of 3,500, there were in
fiscal year 1968, 1,769 arrests resulting from excessive drinking--10 percent of
them juveniles. Further in the northwest, there were 445 disorderly conduct
arrests and 72 liquor possession arrests in one year in a population of 2,300. Male
ults outnumbered both female adults and juveniles by a ratio of 5:1.5.
The cessive use of alcohol clearly has a tremendous impact not only on the
)iyes of individual Indians and their families, but on the tangible and intangible
yoi.Krces of their communities. Nearly every person, whether a drinker or not, is
tWck in someway by alcoholism. A poignant example comes from a reservation
where a recent survey of high school students showed that no less than 339 out of
350 persons disliked giving in their own community because of excessive drinking!
XD SuMMAnn on In sX DUG AuoMss
"'The recent experience of the Indian Health Service Mental Health Programs
has disclosed an alarmingly rapid increase in the occurrence of drug abuse among
SIndian people-particularly children, adolescents, and young adults. In the first
quarter of calendar year 1974, the number of cases seen increased by almost 50
percent over the proceeding six months. In many communities, a majority of the
children are all regular users of toxic inhalants and there are indications that






36

broader, more expensive drugs are being introduced. The same factors wlich
have produced several generations of alcohol abusers may today be producing, a
generation that abuses alcohol as only one of a variety of dangerous substances.'1-
INDIAN HEALTH TASK FORCE. ,
Testimony received by this Task Force as well as preliminary studies such as a
1975 survey of "Drug Use Among Young People at Zuni" done by the Ipdian
Health Service, and a 1975-76 study of Fort Sill Indian School students done by
the Human Ecology Learning Program, Inc., indicate that the use of marijuana
and solvents is increasing among young Indian people. A recent study of 15,634
students in grades 6 through 12 in Anchorage, Alaska, revealed that a "hiGher
percentage of Native [referring to Aleut, Eskimo, and Indians] than any qther
racial group indicated that they used at least one drug other than alcohol or
tobacco" (P. 663, JAMA 223(6), 5 Feb. 73). The most commonly used other
drugs were solvents and marijuana. It appears, then, that drug experi-
mentation is an increasingly common occurrence among young Indians.
The dangers of drug experimentation fall into at least two categories: (1) harm
to health and life, and (2) illegality of the drugs. The distinction between these
two types of dangers is clear where solvents and marijuana are concerned.
Inhalants such as aerosol sprays, gasoline, and paint thinner are legal, though
the injurious effects of their inhalation are well documented. Hundreds of children
have died or suffered serious tissue and brain damage from this practice. Recent
reports also point to a link between inhalant use and aggressive or destructive
behavior. Much more attention must be given to this problem which is partic-
ularly prevalent among poor reservation youth. The dangers of aerosol sprays
should be thoroughly explored before such substances are allowed to be marketed.
The introduction of an irritant to the solvents, as was done with glue when glue
sniffing was prevalent, should be seriously considered. School personnel must be
taught how to deal with the problem, and an educational campaign against
inhalants is necessary to combat this growing problem.
In contrast to studies on solvent use, research on marijuana has not proven
that is is harmful to health. Strict laws against use and possession, however, lead
to arrests and imprisonment of Indian youth. In 1972, the National Commission
on Marijuana and Drug Abuse, after an exhaustive two-year study, found that
marijuana was not as dangerous as once believed. While not advocating usage,
it did recommend continued research into marijuana use and decriminalization
ef the user (Drug Abuse Council, July 17, 1974). The Council also recommended
the removal of all criminal penalties for marijuana possession and personal use.
The incidence of Indian arrests and convictions already far exceeds the number
commensurate with the population of Native American people in this country.
This Task Force does not view substance abuse as a criminal problem, but rather
as a medical or social problem. Efforts should be made to keep Indian people out
of jails and prisons which introduce Indian people into criminal society and only
increase our problems. As stated by Dr. Bryant, President of the Independent
Drug Abuse Council, "even if marijuana were eventually shown to be as dangerous
as alcohol or tobacco, giving a criminal record to the user only exacerbates the
potential harm."
E. SUMMARY OF LETTERS RECEIVED BY INDIVIDUALS, PROGRAMS AND TRIBAL
REPRESENTATIVES IN RESPONSE TO QUESTIONNAIRE
SIZE AND SERIOUSNESS OF PROBLEM
All responses ranked alcoholism as within one of the top five problems of the
American Indian population within the community. Many said it was the number
one problem or at least one of the most important problems. Typical responses
were: "Alcohol directly affects 50 to 70 percent of the population and indirectly
affects all of them", (STOWW); "With a total population of approximately 3,200,
my estimates are 75 percent of the adult population use alcoholic beverages, of
them 60 percent are abusers or alcoholics" (Governor of Pueblo De Acoma).
Reasons given for the seriousness of alcoholism were:
Unemployment or leaving the job because of drunkenness; disruption of work;
arrests, trouble with police; health failure-destruction of mind and body; death;






37


deterlotloo of family; child neglect and/or abuse; loss of self-respect; non-
qrticipation in the community; auto accidents.
' *Ri Of statements were:
1iMe.e1t of job terminations are due to alcohol" (the United Tribes Edu-
0 e8hifcal Center of North Dakota);
"173 ti cet of a arrests over the past year were directly related to alcohol
fbuse5h (Ec1 Tribal Police Department);
S"A Aet tiudy showed 57 deaths among Zunis in a 54 week period of which
j4 &or W)*ent were alcohol related" (Community Health Education Zuni
Shd fa Hospital).

I, ............ CAUSES AND CONTRIBUTING FACTORS CITED
SLack* of employment was the reason most often mentioned. This was often
|en as related to loss of individual self-esteem and to lack of activity, which were
other commonly cited reasons for alcoholism. Loss of Indian culture was also
aM contributing to feelings of inadequacy and lack of self-esteem. The
.exawpls set by other Indians was an often-cited reason and was fre-
qotbL 'stiwed in conjunction with community lack of understanding, or
apaty toward the problem. Also mentioned were splits between the old and young
people and children going away to boarding schools. It was stated that since the
*Min in boarding schools, the adults did not feel they had to be good
examples for their children.


2t~'


Nu
an


4,


Unemployment, poverty
Boredom, lack of alternatives, recreation
Drinks example set by tribal leaders, parents peers, or program staff
(d -1adnstereotype).,---------------
Los etIndlan culture -. .. -_...
Community apathy about alooholismn--------------------------
Lack of good education and skills----------------
No sqlf-tpem, pride_
t119'jtoblesk (including broken homes and loss of family ties)-------
Lack of alcohol (Preventative) education- ----------------
Lack of ed tatmnent personnel- ------------------
LIM*ftqtqate treatment facities..................
faMteatmoel---- ----...... ------------------------------
Bpim ent jof program funds....
6it w"o oppression by whites ------------------
M i predisposition towards alcoholism_. .. .


aber of
em cited
23
18


.SERVICES
dflLlctI
No one felt that services provided were adequate. Two programs said they had
ddquts progams but needed to reach more people and extend preventive
!- h sc i e ea /. ..
qias. ready provided included:
'Cotijielng-----------------------,--------_------14
Sal-way house .........-11
ah-ihos 10
Detofication-------------------------------------------- 6
.: r. ..ws _serwvices .. 4
"entadlw service----- 2--------------------2
: Pre mention, educational pro.a._.. .....--.- 12
Prevention programs were mentioned, bat they were often seen as inadequate.
ilt. mut. often consisted of a counseling program of some kind. Man
p e said that services were not readily accessible or appropriate for Indian
people, such as an A.k program may miles away in a white community. Another
problem often mentioned was that, though service were available through various
different agencies, most of the community was mnot aware of these services.






38


Services Wanted
Prevention, educational programs---------------------- 20
Teaching or restoring traditional heritage and culture------------------ 15
Good counselors and counselor training-- 13
Recreational programs 8
Community center and community organization---------------------.- 7
Medical care and detoxification--------- 6------------ 6
Family services (to family of alcoholic) ---------------- 6
Half-way house------------------------------- 5
Outreach program counselors-------------------------- 4
Coordination of services and funds----------------------------------- 4
Indian support groups (including prayer groups) ------------ 4
Research------------------ ------------------------------------ 4
Employment-------------------------------- 4
Good follow-up programs2----------------- -- 2
Even though these responses represent many alcoholism treatment programs,
the most often mentioned need was for prevention and education programs. A
need was also frequently expressed for returning to traditional heritage and cul-
ture, and utilizing the Indian culture in treatment programs.
LIST OF INDIVIDUALS, PROGRAM, AND TRIBAL REPRESENTATIVES RESPONDING TO
QUESTIONNAIRE
1. Blackfeet: Blackfeet Alcoholism Program and Detoxification Center
2. Seneca Nation: Mike Myers
3. thru
6. United Tribes of North Dakota:
Warren Means, Executive Dr. Educational Technical Center
Russel Gillete, Halfway House Manager
Curtis LeBeau, Director Alcoholism Program
Luis Little Owl, Counselor
7. Rincon Band, San Luiseno Mission Indians: Max Mazzetti, Tribal Chairman
8. Warroad Indians, Minnesota: Rose Johnson, Tribal Member
9. Crow Agency, Montana: Marilyn McIntosh, VISTA Volunteer
10. Mason County Washington Indian Community: Marlei Peterson, Community
Member
11. Small Tribes Organization of Western Washington: Donald Galanti (STOWW),
Alcoholism Program Director
12. Four Holes Indian Organization, S.C.: Diane Davidson, Manpower Aide
13. New England Schaghtioke Indian Association, Massachusets: Princess Necia,
Secretary
14. Hopi: James Brenneman, Director Hopi Alcoholism Program
15. White Earth, Minnesota: Robert T. Rutter, Program Administrator White
Earth Chemical Dependenty Program, Inc.
16. Golden Hill Tribe, Paugussett Nation, Connecticut: Aurelis H. Dyer, Chief
17. Omaha Reservation: Bob Shelly, Executive Director of Macy Alcohol and
Drug Abuse Board, Macy Industry.
18. Ya-Ka-Ama Indian Educational Development, Inc., Healdsburg, California:
John Foster, Executive Director
19. United Tribes Council, Sacramento, California: Virginia Card for Health
Committee
20. Tanana Chiefs Conference, Inc. Alaska
21. Kaibab-Paiute Tribe, Arizona: Mrs. Geneve E. Savala, Community Health
Representative
22. Shoshone-Bannock Tribes: Fort Hall Alcohol and Drug Program Proposal
23. Turtle Mountain Counseling and Rehabilitqtion Board
24. Riverside Indian School, Anadarko, Oklahoma: Robert Lawrence, Pupil
Personnel Director
25. Pueblo of Acoma, New Mexico: Merle L. Garcia, Governor
26. Gilbert Ortiz, Alcohol Treatment Center Client
27. Navajo Area, Fort Defiance Agency
28. and
29. Tribal Chairmen






39

a& Case worker
31. Rwibn X Indian Alcoholism and Drug Abuse: Helena Andree, Rural Coordi-
In Counselor
JRjW: g#pswa Indian Risiervation: Arthur P. Dashner, Counselor
*dgiva Chijpma Indian Reservation
e rxins for Community Act* n, Inc., Flagstaff, Ariz.: Mae Helen
mlive " 'o
Courwelpr-Coordinator
uskokwi* Health Corporation: (Affili of the Alaskan Federation of
Alsiisg L6a#ue-- Irene Moller Acting Health irector
WIn s.Munsee Alcoi;&Z Program of Wisconsin: Aught Co, his D' ctor
2 U.: Morris Dyer, Community Health Education, 7.H.. Indian
Hospital
onz )U I ver Native Association: Steviart Nicolai, Alcoholism Counselor
vlt
Nelson, Re al Technical Assistant
410 Wyandous Trib; of ko
ay elanj= a: Leonard N. Cotter, Chief.
42. Oneida Trik of Indians of Wisconsin: Purcell Powless, Tribal Chairman
thru
Yankoi klioux IV*U:' Community Members
50ik,':, Juell Fai4anks Aftercare Residene for Native Americans, St. Paul, Minnesota:
"]baFramboise, Director
:Hu&Ua,. A&d&:..Rhoda Stertzer
52. Squaxin Island Tribe, Shelton, Washington: Madge Whitener, Tribal Health
MaaWx

... .. ........ .... ......... F. SELECTED STATISTICAL INFORMATION AND CHARTS
AND M01FtBIDITY FOR THE AMERICAN INDIAN ARREST 'RATES
DEATH RATES FOR SELECTED CAUSES OF DEATH (INDIANS AND ALASKA NATIVES ON RESERVATION STATES AND
UNITED STATES, ALL RACES), FISCAL YEAR 1975

Crude Death Rates Ratio of Indians
and Aluka Natives
Indian and United= to United St=
Seledetcams of deeth Alaska Native all
Aad 163.2 51.7 3.2
Cff=__:7
-- ---------------------------- M 7 15.0 4.4
31.7 10.5 3.0
- ---------------------------- 21.8 12.1 1.8
SukWW_


"5WAM-4.4a. HaftService saw almost 50,000 patients with poMems relating to alcohol.
M Judifbdion-of Appropriations fbr fiscal year 1977.

Indian deaW 100,= Pecow increase
or decrease
in Indian Mite
Cam of deam 195S 1973 Sim 1955

Ao"Nft ----- ---------------------------------------------- 156.2 174.3 ...12
-- -----------------------------------------
M 2 131.0 -3
malevent neoplasin ------------------------------------------- 62.1 62.0 0
----------------------------------------------
16.0 4&5 194
--------------------------------------- 46.1 42.8 -7
--------------------------------------
SL 2 41.1 -55
Aso= Of early intancy --------------------------------- 70.5 -72
Inditus --------------------------------------------- 14.1 20.4 45
dclal
Sbiridw ----------------------------------------------------- 15.0 2S.5 70
.......... ............................. 9.4 19.4 106
-------------------------------------- 17.9 10.1
--------------------------- 5& 5 IL
n or u -------------------------- 3% S 5.5 -86

Source: Indian health task fwm







40


ALCOHOLISM DEATHS AND DEATH RATES

SAlcoholism is one of the most serious health problems facing the Indian people
today. The alcoholism death rate for the Indian and Alaska Native during the
past few years has ranged from 4.3 to 5.5 times the U.S. All Races rate. In 1974,
there was a 2 percent increase in the alcoholism death rate from 1973. This, how-
ever, was considerably less than the 23 increase of 1973 over 1972. /
Approximately 59 percent of the alcoholism deaths among the Indian popula-
tion are the result of cirrhosis of the liver with mention of alcoholism. Another 39
percent are the result of alcoholism with the remainder due to alcoholic psychoses.


ALCOHOLISM DEATHS AND DEATH RATES-INDIANS AND ALASKA NATIVES IN 25
UNITED STATES, ALL RACES


RESERVATION STATES AND


1966 1970 1973 1974

Number of deaths-Indian and Alaska natives in 25
reservation States:
Alcoholism--------. ----.---..---------..---------- 55.0 97.0 159.0 164.0
Alcoholic psychoses--------------- -------------- 5.0 8.0 5.0 7.0
Cirrhosis of liver with mention of alcoholism-------- 128.0 167.0 235.0 246.0
Total....-------------....-....----------------------............. 188.0 272.0 399.0 417.0
Alcoholism death rates-Indians and Alaska natives in
25 reservation States:
Alcoholism----------------.. -- -----------------. 8.9 13.8 20.7 20.8
Alcoholic psychoses----------------------------.............................8 1.1 .7 .9
Cirrhoses of liver with mention of alcoholism.-... 20.7 23.8 30.5 31.1
Total.....--------------------.................-- .....-------------- 30.4 38.7 51.9 52.8
Alcoholism death rates-Indians and Alaska natives in
25 reservation States:
Alcoholism.----------........-----------------------. 1.6 2.1 2.2 (')
Alcoholic psychoses-----------------------------.......................... 3 .3 .2 ()
Cirrhosis of liver with mention of alcoholism..... 4.8 5.5 6.0 ()
Total -- -----------------------------------............. 6.7 7.9 8.4 ()

i Not available.

AGE SPECIFIC DEATH RATES-INDIAN AND ALASKA NATIVES AND UNITED STATES, ALL RACES

Homicide Suicide Cirrhosis of liver
Indian and United Indian and United Indian and United
Alaska States, all Alaska States, all Alaska States, all
Age group Native races Ratio Native races Native races

l to 14................ ---------------- 3.7 1.3 2.8 0.3 0.3 0.3 0.1
15 to 24 ---------------............... 30.3 13.9 2.2 44.4 10.9 4.5 .5
25 to 34 ---------------............... 70.0 19.0 3.7 43.2 16.6 57.7 4.1
35 to 44 ---------------............... 43.8 15.8 2.8 21.2 18.1 137.9 20.1
45 to 54 ---------------............... 35.8 10.8 3.3 13.4 20.2 190.8 41.1
55to64 ....--------------- 25.2 8.5 3.0 9.2 20.0 128.4 49.9
65 to 74 ---------------............... 14.6 4.8 3.0 18.3 18.5 69.4 43.3
75 to 84 ---------------............... 17.8 4.6 3.9 26.7 22.3 62.3 32.4
85 plus ----------------... 27.3 2.9 9.4 ............ 14.9 27.3 18.3

NUMBER OF OUTPATIENT VISITS FOR ALCOHOL CONDITIONS, IHS AND CONTRACT FACILITIES. FISCAL YEAR 1975

Condition Total IHS Contract

Alcoholism, acute or chronic----------------------------------.....................................- 18,419 17,076 1,343
Cirrhosis due to alcohol -----------------...---------------------.. 2,102 1,893 209
Total...................................................... ---------------------------------------------20,521 18,969 1,552






41

TE.NUME .OF DICHARGES WITH A PRIMARY DIAGNOSIS OF AN ALCOHOL-RELATED CONDITION FROM HS
.. ANDOW'tRACT HOSPITALS, FISCAL YEAR 19751

..Contract
I M,.,:Lr. uile i : Total IHS hospitals hospitals
AN lt .-"-................-.."..'"-.--.-.-.............. 5,414 3,958 1,456
5.490 392 178
asil.......................... 4,314 3,198 1,.116
536 401 115
as~i )1l di (571.) ....................................... 53 4143
l (9 .... .. ..------ ------------------ --- 65 4 1 24
efftohalin combination with other drugs (979) .......9 6 3

i Provisiunl eflimues.

LNADISX CAUSES OF DEATH, SELECTED STATES, CALENDAR YEARS 1972-74
M .. Al.ska: Accidents
S...... Accidents Cirrhosis of liver
SDiseases of heart Wyoming:
, .. Malignant neoplasms Accidents
Nw IMexico: Diseases of heart
SAccidents Cirrhosis of liver
.4 Diseases of heart Washington:
Mdalifgnant neoplasms Accidents
t: N--t. Dakota: Diseases of heart
S Accidents Cirrhosis of liver
SDsases of heart Oklahoma:
SMalignant neoplasms Diseases of heart
....Uth: Malignant neoplasms
A$pdents Accidents
Diseases of heart Nebraska:
Cirrhosis of liver Diseases of heart
Nevada: Accidents
Diseases of heart Cirrhosis of liver
Accidents Colorado
C irrhosis 'of liver Accidents
Oregon: Diseases of heart
Diseases of heart Cirrhosis of liver
4S0lource: Vital events Branch, OPS/DRC/IHS, January 2,1976.
!", .PERCENT OF PERSONS WHO DRINK ALCOHOL
: *
S1 [1 Central Plains reservation]

laSage: Total Male Female
1. ... ... ........ ... .... .. . . . . . . . . . . . 0:
1511--------------------------------------- s5 so 40
201 .29---------- ...-..-....--........................( 99 72
..L.. .........--------.---------------6.6-----.--- S3 a 85

INot aveitae.
lem me: I1S Task Force Report on Alcoholism, 1967.







42

AMBULATORY PATIENT CARE REPORT-FISCAL YEAR 1975, SELECTED EXTERNAL CAUSE OF INJURY, TOTAL FIRSt
VISITS, AND PERCENT ALCOHOL RELATED
Percent
Total 1st alcohol
External cause of injury visits related I

Motor vehicle.---------.---.-----.............---------------------------------------- 9,073 ...-.-..
Alcohol related-....-.--------------------..............---------------------------- 2,783 30
Water transport-----.-------------. --------.-------------------------------- 171 7 --
Alcohol related --...----------. ---.......-----------------------.--------------- 21 12
Accidental poisoning-.-----------------------------------.............----------------- 760 ---------
Alcohol related-----------....--. --.... --.....----------------------------------- 56 7
Accidental falls---------- ---. ----..... --..... --------------------.----- --- 37,404 ----- ---
Alcohol related --....----.-----.--.. ------------------------......-------.- -- 2,31 7
Fires and flames-.. ---------------------------------------------------2,279 ----------
Alcohol related...-------------------.------.... ---------------------------- 175 8
Environmental factors.----. --------------.-------------------------- 6,062-----------
Alcohol related--------------.-----------------..-----...--...-------------- 361 6
Drowning and submersion---.....---...------------------------------------------- 61 -----
Alcohol related-----------------------------.........--.------------- ---------- 13
Cutting and piercing objects-....----..-------------------------------------- 13,520---------
Alcohol related---...-----.-----. ---------------------------------.- --- 1.262 9
Firearms accidents-................----------------------------------------------------- 478 -----------
Alcohol related...---------------------------..----------- --------------- 98 21
Machinery--------------------------------------------------------- 2,396 ----------
Alcohol related -- ------------------------------------------------ 56 2
Suicide attempt ------------------------------ ------------------------ 851 -........--
Alcohol related ---------------------------------------------------- 391 46
Injury purposely inflicted------------------------------------------ 14,129 ----
Alcohol related --------------------------------------------------- 8,068 57
Battered child ----. --------------------------------------------------84
Alcohol related ......------. .------------------------------------ 32 38
Other causes ------------------------------------------------- ---------- 29,938 -- --
Alcohol related-.---- -------------------- 1, 758 6
Total injuries----------------------------- 122,997
Alcohol related----------------------------------- ----------- 18,158 15

1 Percent calculated from crude figures by task force.
Source: Indian Health Service.

NUMBER OF ARRESTS BY TYPE OF OFFENSE, AMERICAN INDIAN-JUVENILE AND ADULT, STATE OF NEW MEXICO-
CALENDAR YEAR 1974

Juvenile Adult
Types of offenses (under 18) (over 18) Total

Offenses against property----------- --------------------------- 217 293 510
Offenses against persons.---------------------------------------- 55 515 570
Offenses against public safety---------------------------------- 1,531 9,455 10,986
Total offenses ---------------------------------------1,803 10,263 12,066

Source: New Mexico Uniform Crime Reporting&

NUMBER OF ARRESTS BY SELECTED OFFENSES AGAINST PUBLIC SAFETY, AMERICAN INDIAN-JUVENILE AND
ADULT, STATE OF NEW MEXICO-CALENDAR YEAR 1974


Juvenile Adult
Offenses against public safety (under 18) (over 18) Total

Narcotic drug ------..-..----.------------------------------..------- 47 48 45
Marihuana....------------------------------------------------.......................................... 25 34 59
Synthetic drugs and other dangerous drugs...--------------------------- 22 2 24
Driving under the influence -------------------------------------- 33 787 820
Liquor laws----........----..- --------------------------.------------ 243 574 817
Drunkenness........--------------------.........-------------------------- 151 4,568 4,719
Disorderly conduct ----.. ------------------------..----------..... 416 2,516 2,932
Vagrancy ------------------------............................--------------------------- 1 2 3
Curfew and loitering violations ....-----------------------.. --------- 332 ------------- 332
Runaways-------------------------------------------------........................................................ 99 ----- 99

Source: New Mexico Uniform Crime Reporting.







43

NUMBER OF M STS BY SELECTED OFFENSES AGAINST PROPERTY. AMERICAN INDIAN-JUVENILE AND ADULT,
................ STATE OF NEW MEXICO-CALENDAR YEAR 1974
.B.. ,Juvenile Adult
Ofleiaails property (under 18) (over 18) Total

,.Su_-.....q mdentering.................................9 3 52 91
.-..-------------------T-----------------------134 102 236

t h n., receiving, possessing. ----------------------- 7 5 22
Bffil ........uemeii...-........... .2."-......... 29 52 77

sy^^T'^"-26----------------------------------- 51 77

S see: New tesco Uniform Crime Reporting.

NMBEom OF ARRESTS BY SELECTED OFFENSES AGAINST PERSONS, AMERICAN INDIAN-JUVENILE AND ADULT,
STATE OF NEW MEXICO-CALENDAR YEAR 1974

Juvenile Adult
OfDisse .ainsi Persons (under 18) (over 18) Totals

turier sand mmmmuigeit manslaughter ----------------------------- 2 63
AuMraus-d mmIt------------------------------------------ 19 150 169
---rusm-i- -----------W--.-.-- 21 135 156
--ia-------------------------------------- 6 138 144
I .cl ....uln ~ i n ..........e .. . .. . .. . .. . ........


- 1 -mw MlsU cos Uniform Crime Reporting.
S` "WHITE LIGHTNING AND THE REDMAN"
CITY ARREST DATA

All Liquor AU alcohol
offenses law Driving Drunkeness related

Indium rep arrest a proportion of all reported
aris-.-._- ---.-------------- 2.1 1.9 1.0 5.9 5.1
-i...---------------------------- 2.2 1.8 1.8 6.2 4.9
Non-Indian Ratio of Indian Proportion of non-
Indian
6 So-ael ed arrests as a proportion of all
Snt (pmesotag except for coL 3) among
.^gL-------------------------- 7BL4 30.7 2.17
-- .-.. -- 75. 0 33. 0 2. 27
-------------------------------------- ---- 75.0-33.0-L-27

CITY ARREST DATA- 18 YR AND YOUNGER

All Liquor An alcohol
offenses law Driving Drunkeness related

lNtes reported arrest as proportion of all reported
I-.-...................... 0.8 1.9 1.5 4.3 2.7
I -----------..--..------------------.. .9 1.8 1.3 5.2 3.0
Ratio of Indian pro-
Amosg Indian Non-lndians portion tl mon-lndin
A ukohol-rlated arrests a proportion of d
errs (percentaes except for cal. 3):
170 ....................................... 2.3 7.0 3.33
1971 ...... .... ...... ...----------------------------------- 2L 1 7.2 3.49







44


RURAL ARREST DATA


All alcohol
All offenses Liquor law Driving Drunkeness rebtd

Indian reported arrests as proportion of all reported
arrests (percentages):
1970 ---------------------------------- 3.8 2.7 3.7 2.9 6.2
1971 ...------------------------------ 2.8 2.7 2.5 6.5 4.4

Ratio of In.dian pro-
Indians Non-Indians portion to no-inditis

All alcohol-related arrests as a proportion of all arrests
(percentages except, for col. 3):
1970.------------------------------------ 59.0 35.2 L 68
1971...------------------------------------ 53.9 33.6 1.60

All alcohol
All offenses Liquor law Driving Drunkeness related

Rural arrest data-18 yr or younger Indian reported
arrests as proportion of all reported arrests
(percentages):
1970----------.. ----------------------- 3.8 3.2 3.5 16.6 6.3
1971...-------------------------------- 3.2 3.0 3.2 15.7 5.8

Ratio Ef Indfat pio-
Indians Non-Indians portion to non-Indian
proportion

All alcohol-related arrests as a proportion of all arrests
(percentages except col. 3):
1970...------------------------------------ 23.6 13.9 1.70
1971---........--------------- 25.1 13.6 1.85


ALCOHOL WORLD RESEARCH, 1975
Total overall economic cost to the American economy is estimated at i$25
billion/year. This has been broken down into the following cost areas:
Cost area: Bizienm
Lost production ------------------------------------------ $9. 35
Health and medical---------------------------------------- 8.&29
Motor vehicle accidents---------------------------------------- 6. 44
Alcohol programs and research --------------------------------: 64
Criminal justice system------------------- ------------------- 0. 51
Social welfare system------------------------------------------ 0. 14

Total-------------- -------------------------------- 25.37






46


STwIOW 101P Mons. F.I L, STATS, AND LOcAL Aoxzcms
57 l % ACTING OM MfCOHOMUM 4 A RG BTABCs 115: .; .4.,
A cx oINsad AlNoholiaxa






i:: ^ iii Service Plans in States with Large Native American Indian
aw,

i.e. r m .io .....


$tlt ,kiifMlift lMbifliruYW 0N AWCOEOL ABUSE AND AraoumOxl
I4 -bba ji 4
Calr lma Aamdun



1 Baith ServicePlnsi Task Pore ot Aelcoholism stated that
.1 suioies andes accidental deaths, and iajris are associated
M n, W:e many c oases of infetotus iho, and malcutrl.
^ilpiill1teihf aaiortyof arrests, fines, and impuiseamnents are the result of
ll Cl A part of the President's m essae to the American Indians ia
4d ioJidollars were Acoma Lted to begin d lopmt of needed
,:,Iipropams carried out in cooperation with the NIAAA
no vus to m re public T understd and and swamisa of the
d, sttides. cqrmunitys, attitudes; to support rehu resources, to
i ."ZfpefogmaPni for Indian y outh; and to design ad watlon and
S i e fieSld of Indian aloohobisn She Insirtoteh jiest are
|:i|| .IE Joefidential ares individts eOliS a job paisedc t, referral
ii| ip, therapy, Indian AA groups, recreation antse govw..unimum The
^C~tlllil~pet'^hes prjecshowever, is the integmatla of the Inidian cultural
t~ll^^ into w^Frhfg through individual tribal mcxse^ and amphiiiahaga the
*~ w b ofi^^pTbi'^ awb'f~fol^ abuse arnd alcoholismB among Indiani peoplep requires
I.'hWIjs idpindte~ technical assistance in developing Indian alcoholism
1|11|| inh% for Indian people, research into psycho-nodial variables of
y snd .ooholsm among Indian people, ad suffioent funding in.
...... .....!e.. e..ff._.vely wth th., major health problem. The Indian Health
SIe. ernaret on es approach, otorther with the Indian
w'.irl i'oe.',,i .^Tytfu.jpe1!!1 canij wnflt. ue 0bjecnves.nounz be anu. wno wui
::nsatlol poey wpith respect to the dlvery of more effective
i ev og tliemAsfon Indian and ask Nativ coidiei!es
i therp In n Indian and Aoask c n Nttvu P mora of TSe
...WpeWt. pxeattent and RehabiUliof"tns tMto shist
Sf a Ni, IV f ql ebUnities, s, staes td ot bra of the federal
w~r~t trouh idivdua trbal:.MiM aNu#e the~idv




dSlabl a ie aleohotn abuse and alcohoHsm tramnen an remad itaton
...:for basic ieto of approach to accom"..h this purpose ara been
^jiflB~yilJIlK A i*M:: ial cohoi sm**^T~^B_,Bf' a Bmon Indiiljh Lan peop ^le *aid.aM sffi dent fclfif 11di if whVk m .



Thnooi It 0n on! hb adlIan
sat untM:k s Wppp rtect oe he co t iy American effectiv-
7,.#w ttfttee md-5 ir asIaCefa
-Infleiet dia Eu~dhwand'Aaku tii crlI wf-hich


*1 ''Itist~pa l buencrcy 7kV onf Dheskeen
S... ... .... !"'Ause aind ilah m e t o M.D

Of. i kne.can..Wow
tUr an Inf


...... .. . . a
,. ,~ i"; i= .... ...&= ..== W& == ... = VO N it A i* = ... .' ...
'u~ ~ ~ ~ ~ ~ ~~~~~~~h ',.',a=Vlfi.k.,*,=i iawhri.chv ",,, ,.ID,. '~r .m,






46


The Division has also worked cooperatively with other federal ikenoies &deani
with Native American alcoholism to promote more effective utilization of existing
resources and in the shaping of more effective national policies regarding Naive
American alcoholism. An example is the pending NIAAA-IHS Memobandt Agreement by which NIAAA and IHS will work closely together to deVelop more
effective alcohol services and to maximize existing resources. r
The Division has carried out its basic methods of approach at cofimuriityevei,
supporting Native American's ideas of programming and services ikheh ReI 16eent
their own organization, staff and control; programs designed to provide a'Wliety
of services which may include residential care for problem drinkers, inividual
counseling, job placement, referral services, group therapy, Indian AK groups,
didactic lectures, work therapy, recreation, self-government and cultural support
activities, public education, training of Indian people and development of7com-
munity services.
INDIAN HEALTH SERVICE
The Indian Health Service (IHS) is a component of the Department of Health,
Education, and Welfare's Health Service Administration (HSA), which is working
to improve health services and promote better health for all Americans. The
responsibility of the Indian Health Service is to 518,000 American Indians belong-
ing to more than 250 tribes and 38,000 Natives living in 300 Alaska villha&g.
The problems that these citizens encounter in preserving health and obtaining
needed health care exceed those of most other Americans. The goal ofthe Indian
Health Service is to raise the health of the Indian and Alaska Native peoplrtoUe
highest possible level and assist them in every way possible to achieve a better
quality of life. Interacting with other HSA activities in many mutually benefcihl
ways, and with public and private agencies, the IHS is developing innovative
ways of dispense health services, utilize manpower, stimulate consumer particpa-
tion and apply resources. In this effort, the IHS has three major objectives: .
To assist Indian tribes in developing their capacity to man and manage
their programs through activities such as health management training,
technical assistance, and human resource development and provide every
opportunity for tribes to assume administrative authority through con-
tracts and delegation. .,
To act as the Indians' and Alaska Natives' advocate in the health field to
generate other interests and resources which can be utilized. J.:
To deliver the best possible comprehensive health services, incluabu4
hospital and ambulatory medical care, preventive and rehabilitative services,
and to develop or improve community and individual water and sanatioUn
facilities and other environmental factors affecting good health. .-
Organization of the services
Headquarters.-The staff of the Indian Health Service headquarten incluej
health and administrative professionals and clerical staff who support overall
operations and provide advice and guidance to field offices. The orpanizatioa
strucutre and activities of the staff are geared to serve as a resource for field staf
personnel in management, administrative services and various health discipe.
Field Administration.-The field service is divided administratively into e"d
area offices and three program operations. Each area and program office i
responsible for operating the health program within its designated geographical
area, utilizing Indian Health Service or contract facilities, to provide compxr
hensive health care services. .
Service Units.-Areas are broken down into service units to facilitate operation
of the program. A service unit is the basic health organization in the Jxidina
Health Service Program, just as a county or city health department is the basic
health operation in a state health department. These are defined areas, usafly
centered around a single federal reservation in the continental United Sta.e or
a population concentration in Alaska. A few units cover a small number of reser-
vations; some large reservations are divided into a number of units. The Navajo
Reservation, which covers 24,000 square miles in three states and has a service
population of approximately 98,000, is divided into eight service units. Most
service units encompass a hospital or health center staffed by competent teams.
Research and Training.-The Office of Research and Development in Tucson,
Arizona, combines the Service's Training and Health Program Systemsi Centers,,
and the Papago Reservation Health Programs. There, new methods and tech-
niques for health care delivery, reporting systems, and manpower resources, an4I
utilization are being developed to provide new insights into the improvement o0
health care planning, programming, implementation and evaluation.






47

*enr1ka1b &Al t p ngram
SB a STvIce Program Is designed to cope with the
"~th e .eedlat.of ndian people and Alaska Natives. It provides
|.) n preventive 'nd rehabilitative services through
il 'm manj.ower, ahd health programs Planning and
i.0 4 ealth services program rflect the cooperative
lWt heand administrative professional staff and con-
61 t Indian people and Alaska Natives. Tribal health
I0 ntG de velopment activities, Indian training and
j l^^M;. and o16al health activities all help "to assure
4e a.tviti& nd other provided through tribal contracts
WIUS.L t #O p t9 inab-le TIdians to man and manage their own program.
nW imt ii number of private, state and other federal governmental
h....b ns.ress have. been mobilized to Moist IHS in it. mission to improve the
14 4a. people an4 la4a Natives. These include programs of
of .,i> ".i02 i the Deparent of Health, Education and Welfare, the
q and. 'Urban )eVelopmennt, the Office of Economic Oppor-
9 Li !". t'e DeQart7ent of Labor, and the National
I Opt nuhbeir of states; individual Indian tribes, and
; a vte and voluntary Indian interest groups.

bT ared put through a systemm of 51 hospitals, ranging in size
,hh a t r,. $ ing and research centers; 86 health
268 hd l health entrs; ha nd' re than 300 health stations and
"cmi. Additional medical and dental clinics are held at ap-
0U14? tlsedule, daily, weekly or monthly. Special clinics
y lhee.ded. 'onrnacts are also maintained with over 300
JEits inore than 18 state and local health departments,
.,den and other health specialists to provide hos-
ed diagnostic and therapeutic services. The contract
pXw wlax i, l "0ed in locations where there is no Indian Health Service facilities,
bs~tx jmrefusslocal, or alternate resource to provide the required service.
I pe ni~~~its havw a hospital or health center and a number of satellite
alpvtdig inpatient care and outpatient services through preventive and
S pcial services include prenatal, postnatal, well-baby, family
es t diseease, trachoqa, tuberculosis and immunization pro-
IRwvj .ei.^ ..ar. provided by public health nurses, community health
oelane assi stants), tribal y employed community health representa-
M... Autritionists, health educators, mental health workers, social workers and
iM t w4o a engaged in home visits, in follow-ups on discharge tuber-
t e ust. aud newborn -and mothers, min health education conferences and in
d,3060 0 l ii o .a weo conducted in boarding and day schools operated
tm na eofnd Affakus Department of the Interior and public schools on
.la services are provided at Iospitals, health.. centers and health stations,
Mi ahi datal uts.k n some letations where the Public Health Service has
ts4'1s pondd Wader contract with dentists in private practice. In
~Mk ~travelito remotel ages by barter plane taking equipment
Sfr persons nd 17 yes of age i given priority, a policy that
r Mt.A. the 1.4IM V rie e missing and .led teeth) for Indian
:tUMia ., i tot me in. 18 years. Expanded resources,
eilb.~ :autt^e~ additis anf "deatWl Wu.siants have contributed to a
decreasing DMF rate si t R. ciagal idren and providing caw
M am I..
Up Meath service vided under the direction of TndiUpith
W are anffitef of the IHS total comprehensive health
Staff, the sanitarian worn to combat unf
e ,owdd houslark



odewslopmflta *m at yn:w*.
4N i '. | ,, .. .. ,, 0, ., .,,. z J ." .
~~~~~~~~~~~~~~~ .................. 0 .... ..






48


A Division of Indian Community Development has been established. tolpake e
IHS more responsive to the health needs of Indian people and their cnin re
in managing their own health programs. y ,
The National Intertribal Health Board of 12 'Indian leaders represel a$
areas and program offices, Indian health boards and other committee, is n un*
to develop policy, determine health needs, establish priorities and locate re4
sources at each administrative level throughout the Indian Health $ele.
addition to health programs, social, economic and other aspects of bette h t
and quality of life are being emphasized. Existing problems are being identife4
and new resources and health related programs are being developed to W ear ypn
the problems of health services delivery. The involvement and sdbseq t 0on-
tributions of Indian groups have led to changes in health services delivery mehd
and more effective adaptations of health services in a number of IHS 1opttioas.
New community initiative .
Indian and Alaska Native people have taken the initiative to develop nd
operate a variety of local programs to meet their most crucial needs. Msnyt M-
dividuals have taken leadership training in health affairs which they sn'utl n
in their respective reservations and communities. The effectiveness of local ac tio
has been demonstrated in direct community health services activities uch as
programs in nutrition, accident prevention, alcoholism control, suicide prevention,
mental health, improved housing and other areas of community action jwd. -eo,-
nomic development.
Indian self-determination is rapidly emerging as a working conct. It i
uniquely evident in California and southeastern United States where Indais are
managing their. own health affairs.
The California Rural Indian Health Board, under agreement with the Indian
Health Service, is arranging the delivery of a variety of health services to Indians
living in 16 project areas composed of 34 counties. The United Southeastern
Tribes Intertribal Council is managing health care for Indians residing Jn Mib
sissippi, North Carolina, Florida, and Louisiana, through Indian Healtg ervie
and contract facilities in those states. *:
Special programs . ..
The level of health today among Indians and Alaska Natives is in many respects
similar to that of the general population about a generation ago. Physicians
encounter a greater variety of clinical conditions in Indian Health Services
facilities than in other health programs in the country. Special health ueeds ae
met in varied ways with activities keyed to removing the source of the proem
Mental health ..
As the Indian people have been caught more and more in the conflict between
their old traditional culture and the demands of modern American society: .twtal
health problems have increased. The seriousness of mental health problems aMong
Indians and Alaska Natives is demonstrated in age adjusted suicide rates.which
are 1.9 times as high as that of all races and a homicide rate 3,1 times as Mg"
Indian deaths from alcoholism, alcoholic psychosis, or cirrhosis with.alcobis
are 6.2 times as high as in the general population. -
Emotional problems and behavioral disorders are frequent among In"dia
children in their struggle for identity and achievement of self-euftitjenyJa
new social set-up. There is increasing need for the mental health aomonotp.Me
child guidance and counseling, and for the development of new and etive
methods to prevent further trauma to the growing child. i
As of this fiscal year, professional mental health teamsls are working in all Iund
Health Service areas. A pilot inpatient mental health program has been introdutwd
a model dormitory project is being conducted, and training of Indians as mea
health workers and technicians has been expanded. ',:...
The Indians themselves have undertaken innumerable projects* espeOwniaR
in alcoholism control.
Otitis media .. "
Otitis media has always been a serious health problem among Indian& ad
Alaska Natives and in the last decade, has replaced tuberculosis as a majer
health problem inflicting serious and often pemanent damage.
The extreme prevalence of the disease with the accompanying demands for
prolonged treatment, curative and restorative surgery and rehabilitation erected
a workload that was impossible to meet out of regular program resources In 1970,
Congress appropriated additional funds especially for an etitis media programs.







fh tm. 6 Indian Health Service to institute the kind of program
g Shserlou problem under control.
i j '1 -


!i "n .w ...........sq nutritionl Aeficiencies are relatively common
n.Alas U Na&vms espoiafly in infants ad preschool children
S1. l ild-bearig yas of 16 to 44. Malnutrition, a problem in
J LoraiMbutinge. complicating factor in a wide variety of other
I M nd iloneSs. 'To help improve the nutritional status of Indians
an d'l.]tive h IHw eoonduots family-centered nutrition service pro"
ad V HadaptSgroper principls to the food habits and
diaa and Alaaki Native.
,slAaIMDf through the nutrition program of the Center for Disease Control,
iMfcMtotMfli an tod te .Alsks Federation, of Natives have grants to conduct
dmif rat togpama to Ibetter nutritional health by improving foqd supplies,
t Indian worked, increasing participation in food assistance programs and
]l6 iimafauation to Indian and Alanka Native people.

nt- oiUAf sah death aiong infants in the first year of life is met
.il........e...y prenatal care for the mother and continuing care after
l ye tJospit.L HUalth education activities are conducted to
oper ~ways tfeed bathe and care for her family within the
.Oer W&Af 4mIQW to recognize illness, and why It is it-
....g hNC habits and make regular visits to the clinic.
*po g.. .:was. zcently introduced to reach mothers living in
"c0fu *prora mzMa. .w itiated in Alaska in 1970 t6 expand
4 4 carebfomothers and children and to demonstrate the role a
g|p|Xlay in reducing maternal and infant deaths. Similar programs
741 1t i. n Shiprock, New Mexico, and in the Fort Defiance,
yChOalie Sevimce Units in Arizona. Nurse midwifery services are
......p i. Fine Ridge, South Dakota, and Lawton Oklahoma. In
te d Schoos of Nursing, University of Utah, and John Hopkins
F&4 Frogrim i s being expanded to other areas.
: BUREAU OF INDIAN AFFAIRS
.The Duria, in its Washington office, employs one full-time alcohol and drug
4 .wn ae '-t who serves as liaison between the Bureau and other agencies and
H| Qarwbnh speciale in alcoholism or drug abuse information, services or
"4 M e tionf the staff activity referred to above, this Bureau does not
dnA;ro. abuse programs for Indians. Essentially, this is because
SZ ,tprovidad funds to opers' such programs. Al federal funds.
Y| li are cha led by law (Public Law 91-616) directly to the
ttfeori ''oh Abuse and Alcoholism, Department of Health1
Welfuare, whici m turn, is responsible for the total federal alco-
~Ia. rrgnt has Mbeen reaffired by the Office of Management
n tie ocaaions when the Bureau has requested funds for alco-
4 Sf hiSwm s Affeira whw.
n..' oflhe 1TA, cbieulum is defined simply aos the planned activities
WXit I on wha takes plcebetwen the teacher and
t is h Ae responsibility of a number of
..l...i".t "pfier" p etndent parent Area Office and
^^H4ilKh^e'*eotf 6ducatlon limb a diff'erat responsibility'.
Office, uri development i vested the Director of
who in turn ssip it to divisions. Each Central Office division has
..e responsIbility in curriculum development. For imstance, the division of
.. jrkaji.th. cal educton as related to physical and
,H.u"tci, Itema~ and nuusprnntt

MW d. ...Arela~
.14. tltt h z'a loevl l haev t
It Is at thsevel h






50

teachers are hired, that curriculum content is reviewed and detii97 -_ i4It.
matters relating to the students carried out. In effect, Area O0 "i.ta.
school districts whereas the Central Office serves the role of a tradit"onalnstte
department of education. A .
Regarding drug and alcohol abuse in the school program, general dM.i.m
goals are developed at the Central Office level of operation. Thse a fuu
refined at local school levels of operation. In this case, drug ail al1oq8.oqbbs
would be covered under the general goals pertaining.to "Health and Nuftit
It would be at the Area Office and school levels of operations that p. w4 gj&s
would be translated into the specifics of a particular program. *ij.....
The BIA does not have a specific policy or allocation of funds iwn`S3Ipox.t
"Affiliation Agreements." This type of approach to alcohol and drug S iBe
expensive and is not a categorical program for educational purposes. O.a the
other hand, there is involvement of the Indian community in educa-ioul crnu
and alcohol abuse programs which may or may not include affiliations s =a t
the school level of operation. hr ;.. "
Policy in Indian affairs, including BIA education, emanates from a o.u .er o
sources but primarily the Congress and the administration, Thee. t... v oa p
have endorsed the policy of self-determination which adds a third sfp -,"..
Indian tribes. 44.J 't I :
Policy statements developed at the Central Office level pertaihinng eduao
are broad and general so as to accommodate the differences found am' nwghdia
tribes. Area Offices add another dimension and finally, at the eqnMunity o
school level, it applies to immediate needs of Indian children. The seldft 6iW 1
tion policy requires that the Bureau be responsive to Indian tribes hence,
programs such as drug and alcohol abuse are determined at the lauol'lbivel .
Improvement in the system will come from having funding sufflbient tk*.
care of specialized needs such as drug and alcohol abuse. While BIA ehea ha
a great deal being offered in drug and alcohol abuse, categorical fidiiti wu4d
improve the situation greatly. The specialized needs of Indian childiktdiynth
are such that education programs cost more than in comparable *ioxt4ZlA
situations. Bilingual needs, special health problems, alcohol and driug abust and
education of the handicapped are examples of types of education PrdgrtBS th*
need to be expanded but are hampered by insufficient funds. Some foiri o1atteg ii
cal funding that would be available for a limited start-up time then become a part
of the regular base, would be helpful.
NATIONAL INSTITUTE ON DRUG ABUSE : .
Since its establishment in September 1973, the National Instltute i DtMg
Abuse (NIDA) has become increasingly aware of and involved in the problem. of
drug abuse among American Indians. In this brief eighteen-month peim:i, 'the
Institute's commitment to this particular area of drug abuse has mo rease If*
the support of fifteen projects at a total federal cost of $486,00W, to twiAt
projects involving Indians totaling over $1.5 million, with another do
designated for new projects before the end of fiscal year 1975. In addiction
scope of NIDA's efforts has grown from supporting simple prevention dW
ment projects, to more recent efforts in training, demonstration and ne.s
At the same time, NIDA has attempted to insure that a coordinated approhbe
maintained by consulting with federal agencies already involved witn rervqnt.
services to Indians as well as with various Indian amsociationsthanselves.
method will soon be formalized by the establishment of a collaborative constant
group composed of individuals representing such agencies and organiti 0as
the Indian Health Service, the National Tribal Chairmexi'a Assocition a
National Indian Board on Alcoholism and Drug Abuse. The. fiwagl eaCi,
budget will allow NIDA to continue thisprogram at a level of effort c iste$
with fiscal year 1975. Examples of specific NIDA projects in this area ae num-
marized below. i
,: i if '' .
Treatment services programs .
NIDA currently supports fourteen treatment projects in which Indians ar
provided assistance in dealing with their drug abuse prbloteis. A. aut with the
Red Lake Tribal Council in Red Lake,' Minnesota provides services CxAOiU l
to members of the tribe at a total annual federal cost of .pProiatey $2O00,0
with treatment capacity for 150 patients. This otpatte terom
provides the following additional serve: (; individual and koXp cmeig;
(2) remedial education; (3) prevented' service% with fabonoeW $U school 5_US;







IF


111-' ^Nllli lal^^
i:i.ii .:h. "lV^ j j:


61


Sigamteqt;~ M5d (5) cultuval sad wratioal prorSe. The
:: e, i~l ~ etws, or! tmqu. A sewed
la aoatw seg tnd
CabIand Uthe Navajo CQmow Guidanee Oadets Serfim
epwcgs& # d6, oit lsintwveatlon, dstouiht:on, in-
nW ,n;weL -M fIrily, Iadlv usl and group thm, peutio srvice.
gMflaL at federal woe. of about 100,O00 for 60 patIents.


of the Tndfn station in the American society has led the
wand mnntlve method for-addreslng their drug abuse
jtp~ftlp bt~ori ,Cc-aotyeet in Billings, Montanaa supported aten
S. a re example of this approach. pThis J
..!i,4 ...... in.ea of. treatment egmn with. I .dian culture
i 1s.iula .bel that drug addicted Indiant sam best
,l~ ssUM tbega tE tb*Iw Onto with their culture, making use
jwWte^ la their sensetof identity. The treatmentpro-
~ tdg~ts thspet. cmmuitystaffed almost entirely
-- -present alcoholism and drug abuse treatment
i h .Id ns iattkrkibuted to the fact that they separate him from
mg _a S 19O 306 grant with the Western Nevada Indian
Q1fevd, z hics eAacmwting a two-yen program inathe
pg ainneu peusonsi and cultural fawre-
wbAL W Aifetl in whieb -he use of dru, will be
l.utlis~minwie:.ce adult Indian counselora and trained
dS eowi'u c. n .ift in inutotaing pes and. cultural aware-
SINalternativa cor dealing with social and eme-
'k .: a n a'l,;,. .'. [ N..


N ii!


t4 *a,":a


itOUW


n to develop po- ve a&tutu


jf r I 'I fl.it:: ":" ) . '.' : .:" i ... )u 1':*:.,-
dtil-c


in the treat-
is concomi-
rIS among
wiuh thie
is one such
he STOWW
ra session
Salterna-
ian staff are

Motivate


Laes ana1 .t preonie t*fn ponusibmy
to prqwldlng edu nation regarding
s to tgotraditlmn. and loas of the
in the run g of the program.
S .. baked to teat *u4g abusers
i t
Ba^dian kqlmnunty Health
t~~hfl Mriz
AjlrlaxIdian W1?eClinicin
.subc opra.t tbl progra.n
4it7r tfr^IIroatrPeO has~une


. *'lri*c F. ...l" '. a. : j.o" J


=


. B B:i s n...






52


mendation of the tribal councils in the proposed areas. The primary data ghtherfg
instrument is a self-administered questionanire which includes items not:dafliS
drug abuse and knowledge of drugs, but also on perception of a wide nagerof
social and psychological problems. While the study is designed to focus otB
adolescents within the school system, an attempt is being made to survey subset
dropouts. Supervision of the administration of the instrument is by: tried
Indian Health Service workers rather than by members of the school syteaf'"
NATIONAL INSTITUTE OF MENTAL HEALTH-AMERICAN INDIAN
The American Indian has been characterized as the most impoverished and
deprived group in our nation, in terms of employment, income, educationehafltb
and housing. .'
In contrast to a slow growth rate of 13 percent of the American populatot :ia
the past decade, the American Indian population grew by 50 percent in the 1960's.
The 1970 Census reported 827,000 American Indians and Alaskan Natives in the
U.S. The Census reported that in comparison to 14 percent of all' Arerian
families, 40 percent of American Indian families live on income levels belwK te
poverty level. The median age of the American Indian in 1970 was 2W tlgt
years younger than the national median. Almost 50 percent of American:Indians
are living in urban areas. .; : : .
Along with the many other statistical indices of the severe-plight of the A.inknktn
Indian, indicators of extreme and increasing psychological and emotional ldistres
are present. The suicide rate for American Indian adolescents is four times that
of the general population, with a rate 20 times the national average on atileaut
one reservation. The 1973 overall U.S. crude suicide rate was 12.0 per 100,000 in
contrast to the American Indian overall crude rate of 19.4 per 100,000. Other
indicators of the significant mental health need are the extraordinary incideb
of alcoholism, glue sniffing and school drop-outs.
There is a clearly documented need for mental health services especially designed
to meet the unique requirements of the Anierican Indian populations. The resolu4
tion of this problem is made difficult by a severe shortage of American Indian
mental health professionals. There are, for example, only seven known American
Indian psychiatrists. -
Research.-In November 1972, the NIMH Center for Minority Group Metit_
Health Programs, assembled at a National Conference on Indian mental health
issues. A major concern expressed by this group was the need for research d'
signed and implemented by American Indians which is directly related to Amprient
Indian mental health problems. In direct response to the stated need; NIMH
provided funds in fiscal year 1975 to the National Tribal Chairmen's A-sosittiah
and the University of Oregon to establish a National Mental Health `teitAch
and Development Center for American Indians and Alaskan Natives. The pricple
objectives of the Center include: H
1. Conduct research which has been identified as a high priotbfity by
American Indians, Alaskan Natives, mental health/behavioral and SocSl
science scholars, and the Center's National Advisory Committee" '
2. Provision of a research preceptorship for American Indians and AlaskA
Natives with guidance and supervision by members of the same racial groups;
3. Monitoring and coordination of research projects relating to Americaie
Indian/Alaskan Natives, (i.e., projects which are being conducted by other
institutions, agencies and programs); .'
4. Affiliation and collaboration with other research programs focused t o
studies of American Indian/Alaskan Natives; .
5. Provision of technical assistance to American Indians/Alaskan Natiwv
in the design of research and/or identification of resources for support.
Upon request, technical assistance would be provided to non-Anericai.
Indians/Alaskan Natives in the design, evaluation and implementatio4 6
research pertaining to American Indians/Alaskan Natives;
6. Collection, storage, retrieval and dissemination of unique mental health
and social science data pertaining to American Indians/Alaskan Natives;
7. Identification of model mental health research and development reso. urces
and programs relating to delivery of mental health servi"os, manpower
development and research for American Indians/Alaskan Natives;
8. Through the Center's National Advippory Committee, Board of Directors
of the National Tribal Chairman's Association, and other Amerinca Indian.
Alaskan Native organizations and individuals, identification of needs and
periodic evaluation of the programmatic direction of the Center. .







P .0W.s wlltnM ude development of culturally sensitive models
--m .t .....hea lt h services to American IndlansAaskan Natives
as eNdl hdin Indian boarding schools development of a
jflfa lmladhl tfe oslntn ng and/or evaluating the effectiveness of the
...t&.. ...d yicians as practitioners for tiven conditions In selected
; c- ment ofs mental health needs of urban, inner-city
AM erleaa Indin ans d Alaskan NativeI, foster child placement
H -- diil o Native belidt and value systems socialization patterns,
nqu at adjustment); and effects of non-Inmdia testing and counseling
hb&^B~a^. .
'ZDe 0n and Manpwr Deelswn4--By December 1974, the NIMH
fu Woid/0or staffing grants to community mental health centers
4 oy / rrvtions in 17 states. The 39 centers have all or
o011n 6 theirX atchment areas. A substantial number of the
RB i 04 satellite offices so services are closer to people'S
R Ph Four Corners Mental Health Center in Utah,
'zt mlential health workers represents a pferet
low bM'iervices to American Indian populations.
a.t ..ettoige this American Indin manpower gap through
Ssocil worker training, project in Arizona Florida, Okla-
hom. ( on U4tah. American Iendian mental health workers have
.R Aglfomr:O, Colorado, Minnesota, Montana New Mexico, New
Y k th," Oregon and South Dakota. Also, a unique nurses training
rnP^ $4tWd nNoth Pakota.
h a .r'., +!. v ++ +it.s....": f .. ...+ *J ,,. < .. -
ha unitu. ,, -... ::.<. ; OF ICE OF EDUCATION
;, rItele 0=0 of Education issued proposed regulations to carry out
l.l.. cy.ffu +M~e+ of ahd early intervention In al'ohoI and drug abuse.
"'6 made afidhble to local public and private education agencies
tbud ublio aid private non-proft agencies, institutions and
ji hnd al or 6-member team of educational personnel to regional
trait eaters to learn h.W to develop and administer the above mentioned
sgulattionw provide for the following programs and projects:
4...... epmnt, testin, evaluation, selection and dmssemination
o +...ation pr mogram s
R,;,. ...... on causes drug and alcohol abuse, not symptoms.
liJ 1 "' ioir early intervention programs created by the use of an
Yffl^tN1|ry wb.o.1 team" approach, through which skills involved with
ng odu ti ese program will be developed In both the
o publicsudere.d
1 ib* ,eiwi'~ hwervie+ training programsjor "teachers, counselors
+ :, _` iu iil era It' law enforcement Wmcials- public serve d
w U-4t W oly ectio programs-especially parent oriented.
p.m.... n~ditm.ent, traninig and employment of both professionals
Sinvolvemnt in the field (to include recovered drug and alcohol
'fi ;the diuseinatloc of valid and effective uchocl and com-
lins a provide for training and technil assistance to both
.qcatinl agencies a.d community groups. Ts. training
artiio IndtA.1 Zd"ction in regards to 4lcohobim
,.."4. (No0n-LEA) of Title I, as oowmpo1ets o f a
l areas, acohoelisM adb aAru abuse e an
??SPYXRWPUe^^ 1^ ^? 4pjrtarawdr ItS Adian Education
PaWY ;o uuo IV20 9# ~TIU RC&l1)GA
43 1,i.O 7f A A CAK BGAX ,^ ..
cB649dWS Ntl a"~is andi
z ;+,,+ ....R WWVJ+ : at. not andm+
NAtive addf op I nnvtv 'ppoahem for
Alaka Natives a de t ancd -a assistance to able them to
move toward economic self-sufficiency. The purposes of NAP include: (1) strength-






54

ening of tribal governments to enable them to effectively manage. anA.utilze
available resources; (2) support of a range of services to meet iSvmual aa4
family needs; (3) support for establishment and operation of urbaaptgE saving
Indian people living off reservations; and (4) funding to eneourge falp
and community economic development efforts.. :. ,1
Direct-funded grantees provide services which are available to vw!OvSbS,.e1
the approximately one million eligible Native Americans in the ited i"a. ,
The grant program in 36 states includes 273 tribes, groups and Alaskan vilaes, en
well as 58 urban organizations. :,
LAW ENFORCEMENT ASSISTANCE ADMINISTRATION
The LEAA is primarily a block grant program which distributes it. ri4. to
individual states on a population formula basis. The funds are then ditt4 d
through the designated state agency in accordance with the state's a prlnmv
criminal justice plan. These funds and resultant grants and subgrant appictins
are therefore under the state's jurisdiction for approval or disapproval, notli4Ads,
It is through the state's planning agency and comprehensive criminal justi mCLPan
that decisions are reached as to priorities and subsequent funding. :. .
LEAA does retain a small portion of monies for discretionary funding ofpujopts
of national scope and innovative and experimental projects. These grants a o
initiated by LEAA but through proposals submitted by applicants. "' ,
DEPARTMENT OF LABOR- EMPLOYMENT AND TRAINING ADMINISTRATION,.
Under Title III of the Comprehensive Employment and Traiting Act ((CETA)Y
of 1973, the Ddpartment of Labor funds direct grants to Indian reservations and
other organizations. Supportive services, such as initial counseling and referral
to existing alcoholism and drug abuse programs, are offered to the exteab tat
this substance abuse affects the employment and/or training of the indr!Aidua.
The Department of Labor does recognize the fact that other agencies. W,
NIAAA) do have the mandate and appropriations to deal directly with this
problem, but they, through CETA, coordinate efforts with other agencies ..
VETERANS' ADMINISTRATION
The Veterans Administration sponsored a conference from September. 16-18,
1974 on the "American Indian Veteran and the Problem of Alcohol", in Albuquer-
que, New Mexico. Central Office staff members met with reptesentativesof 26
VA hospitals located close by sizeable populations of American Indian veterans.
Strong emphasis was placed on surfacing operational problems experienced in
the management of the VA's alcohol dependence treatment programs a they
provided a broad range of services for American Indian veterans. '
Workshops were provided for all attendees, to increase skills in outrech and
case finding techniques. Participation by a number of representatives'of Indian
communities provided a rich resource milieu of expert consultants. A number of
site visits to Indian operated alcohol dependence treatment programs were made
by the conferees. Through that period of intensive training and collaboration, a
sense of common purpose emerged. The theme of the conference entered on
self-determination by American Indian veterans, while providing for coipre-
hensive and appropriate health service, fully respecting their heritage ad devoted
service to this country. Following this conference, considerable communication
continued on this program area between Central Office and 0our Vetrsrn Ad-
ministration health care facilities. .
To improve services to American Indian veterans, a special subod"mttte
for Indian Veteran Health Affairs was designated, with Dr. Stewart L. BakeriJr.,
named as chairman. The committee was multi-disciplinary, selected from tose
clinical and other supportive services which could contribute importantly to bhe
task. Several site visits to Veterans Administration hospitals and to Amerie=n
Indian and other community health service facilities have been completedjby
this group of VA professionals, usually with participation by DHEW
representatives.
A number qf areas were identified which appeared to merit continuing special
emphasis. Those subjects particularly persuasive for priority attention included:
1. Better coordination-between VA faciities and other coounity
health service activities, including Indian operated .pi. bs
": |. ,' .. L i "-..f .., '







rv e xqw ~uncatioir-tbrough mow accurate and helpful iorin-
Aservices, about existing programs for American Ind4ama, ad
mor effective use of the communication technology.
M aon elgibilty-with facilitation of accs to VA healthOsIUISaY
M information au VA benefit et al1
m di beath care-by 0ev0 aof patiUent now oe-
at tVAosa tasthe hbpItal staflt aIoWnea of and
Ana:' veea in the hospital arem
iaJsp e practe-throuh focus on employWmeat
A-1 or speciued for treatment team
a1Y k...Wa _12-u tual chang. betwqhn VA stat
A Iluxiihe Aerian ndinoommunities.
roeacy proams-through recruitment of American Indian ombuds-
VA hsptals, rom An Indian... communities to. ssi.. in
. viEiblity of. Ameican Indian veterans in hospital ares,
m6 apuw t for suh. vetans ad more effective intea 9 cing with
e fastos:r ,ftca. for.
V Iter. Admintr.ation and the ptment of Healt Uda-
appoved an agency agreement to establish Veteras
on participation in providing veterans benefits in the Navajo


I *q'ij-j v
P. k:
iM' .::-^r7, i "T ":


.... ** ,* :
PLAWS IN STATES WITH LARGE NATIVE AMSmc
INDIAN POPULATIONS


4 Health and Social Services, Office of .Alcohism


swine sad planning the state is divided into three regions and tweuty-two
*lill~tB^4l.dtetcob qerve -s collection points for suurouading villsg s and arc


__o ,,00 are e Indi Alohol abuse is ideatikd
.. .!ps . .5 . .WL4"


ltmull.ga gtee spd Native AlMakma are designated as a
4cenwion amp
t e State.. Pslan.o speaic priority action for native proa
Taken through the Formula Gant Budget for fiscal yer
7 to the Alaska Native Commission on Alwe olisa and
tIS1 w is provided for formula grants to local communities..

f ,...l He Serviced. Community Prgrams Office (includes Mental
V: Ad oout and Drug Abqme Programs)
1 .*** Councils of Government function as planning agents for Stae
'r- k: Arisons kIdil n Commllon o, Alcohol and Drug
"ipt on Indian service probe. "
fl Ind an population Aons is le (114,487) and has been
A atnip' aP for lobh1m ereves. The state's ction priorities
g t d for fisal year 1976 do not specifically mention Native


0 Aw program Maa.met l the. singl stats authdty.
coats ame mepO.aSM for amat
iBH: BB.lw~" CGB.^ _:,. B eeds ..nd... ]jKX'jm. ifXC X'e~pe w **0 : .-BoUM.K w d
I b fj-seeds and.. prooml h ..r .p. t

bl .asi m i tated to the
Wu^-Qiw^S .Pertmet of elbuth~nudhs meehansha. _L
^ite*te -Beadeii ludiibdpDA (6 Wecn ofthUam iori
-11.1pAha buD flW*fRd.s are a av.- .w
* cU Indians apecifteally amnoldeaSa as tupt tromp, or a&A s thay
If for eiter time finkSl ant budget or atiou pdodim. Input a Native


[. ,-: .: ..






56


American alcoholism is provided by the Indian Alcoholism Coitmtision of
California. ii
Montana .
Department of Institutions, Division of Addictive Disease or Department of
Health and Environmental Sciences Alcohol Serviqes Division I .h
In the last several years, the major portion of the state plan moniln he 'been
allocated in six equal allocations, five of these are to five geography al regions
and the sixth is the cultural region delinated by Indian Alcoholism interests and
administered by the Montana Indian Commission on Alcohol and Drug Abuse.
New Mexico : .
Commission on Alcoholism is the single state authority.
The state is divided into seven planning districts with eight ares pining
agencies. These agencies are designated as Regional Clearing houses ai0d are
responsible for review and comment on all applications from their District. "
Formula funds are provided to communities for services. There are a number
of local councils on alcoholism in the state and the community-team apptoa*1 s
stressed. "
There are 73,000 Indians in the state which includes nineteen Peublos and fbrt
nomadic tribes. American Indians are specified as a target group, but are not
mentioned in the formula grant budget or action priorities for fiscal year IWW.
There are eleven Indian programs in operation in New Mexico. Most of these
are funded directly from Federal grant fpnds. However, one program did ieoelvM
$12,668 of formula grant monies. Thus far, input into the State Plan by the
Indian community has been limited.
North Dakota .
North Dakota Department of Health is the single state authority. DTiviNi
of Alcoholism and Drug Abuse has prografn responsibility. "
The Governor has designated, eight planning regions for delivery of hu*in
services. One agency is the legal agency for service delivery in each of the regins.
There are four Indian reservations in the state. 2.3 percent of the total state
population is American Indian. Indians are designated target groups for alcbblismn
service and one of the action plan priorities for fiscal year 1975 was to develop
treatment programs for Indian reservations utilizing an Indian task fotc&. At
Indian Ad Hoc Committee made up of representatives from all reservations
set up to develop treatment programs, using a formula graMt at $20,000 as 1ed
money.
Oklahoma .
Oklahoma Department of Mental Health is the single state authority, The
Division on Alcoholism, one pf ten units within the Department, has responsi-
bility for preparation, consultation on, and administration of the State Alcoholism
Plan.
The state is divided into eleven sub-state planning districts; each district s
an area coordinator. Each resides in his own district and is responsible for plan-
ning, coordination, implementation, and evaluation within that district. Tlwrp is
close cooperation with the area-wide health planning agencies which also review
and comment upon all alcoholism application from their district. The distr"tp
are encouraged to assist the health planning agencies in developing anb alcohoie
component for each area-wide health plan.
Oklahoma has the largest Indian population of any state with 103,650 from
1970 Census and 108,602 by 1974 estimate. Indians are designated as a taret
group, but do not receive specific mention in the formula grant budget or in the
action plan priorities for fiscal year 1975. There are twenty-two alcoholism
programs across the state funded with formula grant monies. Approximately 18
percent of the clients provided services by these programs are Native AimeridaN.i
The United Indian Recovery Association is a non-profit Indian organization
formed by Indian people to provide, a collective representative strength as a
means for rectifying addiction dependencies. There are mine Indian alcoholism
recovery programs in the state funded directly through NIAAA. One program
receives an $8,000 formula grant for a youth project. '























































Sotherm treatment, prevention and rehabilitation services are aMlab
st. Amerlcm, and Alaskan Native throughout the county. Thbae Ica
dto olcntan arpuot vetotbair
Indian a". ot.tPS
nitehIT" Mfsu crs nAf unj u .nnfu
L .a~vlmIw^a..uTi ^4Ywww^^iH^^^ V qeqtlSpm^lB<-^ww wU'"^SIIU4M^r^**


.KRa._fiI __,,_ hGeneral hospitals or cinic
iitO>-:r:. : 1I '*.i I ri *.: Wlrvatid orsapecsu2lub haspitels.
':::_ ... .i ...:* o *: e oi fc ~ n et
...," .. k .A..i i l 7 .. H..C, ., y hous. . i P .
^IP-I~~llll ILMt'' fBpcttn~ti "^ *:*i-.'^
4 WO .d4 Y.t;.,--:.ji i~ iiwu afi. ^rj:


.4 .. 4



:'jii Ci

"1


F *N 43.i
J i :. .:. :0 :.
-JbfnilU' '+, ,I'++, f^,^;: +i [., .. i, ^


SU: :.a a' a


4iU.

tS ry t:" d:..
::" JIM A r' .'. *U. .


prognulo^.!, ** *+ : ti.;1.:'*- ** **
.. .
* Tfy^ P.. ,


..f i.9 a -. *V *:FF.J:* mr r f* C.. M en %


1
H,






58

Salvation Army, community centers, Boy Scouts of America, Chasrfoet!s Cbaii-
merce-all are beginning to assist in offering information, deferral and other
services. ,
THE ALCOHOLISM REPORT, VOLUME IV, NO. 12, APRIL 9, 1972. J.:a ...
Public Law 94-237-This bill also establishes a new Wite' House6 Oi1fte
Abuse Policy, replacing the now defunct Special Action Office on Drg b
Prevention (SAODAP).
However, the Chief Executive noted his opposition, expressed in recent mowxt
to the re-establishment of a Special White House Office on drug abuse" a tvide
in the bill, calling it "duplicative and unnecessary." As 'a result, Mr. pFa
he would not ask for appropriations to fund the new office. The legislation 0utu"br-
izes funding for the office at an annual rate of $2 million. !
President Ford asked Congress, July 1, to rescind a $250,000 apprpi&atio t
fund the Office of Drug Abuse Policy in the White House. The office was tai
lished by legislation enacted last March extending the federal drug abs p tt
authorities (Public Law 94-237) (AR, April 9). It replaces the nowt dcf t
White House Special Action Office on Drug Abuse Prevention (SAODAPJ.:
In asking that the new office not be funded, Mr. Ford said in a me"1
Congress that he had opposed its creation all along and believed that it conatlttautu
an "encroachment on my responsibilities as Chief Executive." *
"I do not need another office with two officials with salaries-of $42,000(fbr Sh
director) and $39,000 (for the deputy director)," he said. L :
H. AN ALCOHOLISM PROGRAM BUILT AROUND A COMPREHENSIVE HEALTH **H M..
Alcohol abuse is one of the most significant and urgent problems facil: the
Indians and Alaska Natives today. Probably no other condition so adversely i
fects so many aspects of Indian life in the United States. Alcohol abuse i =.hrnful
not only to the physical and mental health of the individuals, but "to the fairly
relationships, economic functioning and the'whole fabric of society. It is a problem
that demands attack on many fronts, especially through the provision of a,: ut
health care services. A comprehensive program plan to deal with the health ctre
aspect (physical, mental, social and spiritual) of alcohol abuse is spelled oAt hi1
this paper. The plan has as its. goal the reduction of alcohol abuse iamong.It
Indians and Alaska Natives and addresses five major aspects-the effective wki
efficient administration of an alcoholism program, the provision' of prevntiW
services, the provision of treatment services, and the provisions of rehasflitve
and follow-up services and training. The plan is designed to interrelate the iAth
care aspects with other components of a comprehensive alcohol abuse prograMik
and to insure that the development and implementation of an alcohol abuse pro-
gram is a joint effort of the Tribe, the community, and the Federal Government,
and, of equal importance, would represent the wishes and desires of alcohol de-
pendent persons. :. /
I. ADMINISTRATION <1
A. Development of a data base to define and measure the problem.' *: '+
1. A data committee should be established to define the data bits requiflredit
manage the program and to develop the methodology for collecting the data EMs
the program units. stiici,
The committee should consist of three health professionals, a statistician, and
a systems analyst. The three professionals should be specialists in the area of al-
coholism and have some knowledge of data processing.
The committee should investigate the possibility of using existing data systems
to manage the program rather than establishing a new data base, and create an
alcoholism registry to allow treatment and prevention programs to be constructed
and aimed directly at the patient and his family.
2. The demand made on professional time by patients with alcohol abuse prob-
lems should be determined. .
The data items to answer this question should be defined utilizing an activity
report form. This could be a separate data collection mechanism of be made
part of I.A.1. above.
B. A Federal entity needs to be developed with the capability of managing the
program. The entity should be identifiable with decentralized res-ponibml'ies
and should be directly tied in with the provision of other health caje serWdes.
C. The community must be involved In arriving kt a solutik fdr dealing with
with the problem.






69


.n:.; ,i..


Import~anj~rtncple in tribal leadership
e .t.d bya'ge e tter oodi and
needed. Tribal Iederm in the pst have
hese p_.0 on .tesefations And in
n 6odfe. Too many times the clic
On Oth same reservation;.
I f saotiOned by t. tribal leadersh
I evaluate the local programs. Health
evuSte problems, consult with IHS,
O~~~aet&bli_ means to meet problems
-aug' planing. (b) Identify problems


'ass reeooimena.
program administration should be developed
o- aist in obtaining compliance within 1-2:
?.l . .. . ,. if'
Sam 'drecor should be established inclid-
jpf q-on experience, alcoholism treatment
.aaentl. aspects of the disease. Q(zalification


ur and assist individual alcoholism programs
, and effectively deal with the evaluation and'
0aW management.
Lidd 'lso establish guideliie- for treatment
,for additional services are made in an efficient


ly basis.
Mechanisms for coordination and joint program develop-
Lc and private aenies at all levels-local, State, regional,
I : ' .*'",.; .. ...' ~ .. ...... "* **


&i' heed to be developed and maintained to
Tacilitiese/specalists within a given jurisdiction
natives of this program and indicate for each the
or participation, listing all resources responsive
d environmental needs.
i.d with all agencies having such resources and
refrrals, inclu.ding necessay written contracts
erms required.
tould eestbli .ed ad consist not only of
S .at ae represeatativs toft law enforcement,
S cies to inw. that the broadest ap-
epZograM-preveion thugh rehatilitation-
omntee bekxz continued resource identification


Jl^Woeffectthe rdef utilisation of some.
S cdre of trained Indian professionals/paraprofessionals should be
lwigr alci~ol a.uue. Utilising the nsouuees.prqided by the
|^' = ... eImprovement Act, programs should be developed that, will
e_2r o health professionals t ,,os y deal with : social an.0
.g ot, cia., l:' : e, ind.
|| ^^^^^ff tfnhr l~fA.agIninpepe Iued I& the
_beis sthat provide exposure to the soological AO.reO of
l.' poQ.ty well wegdoftrenNin met odlo
..".... *:: Ih.V... .-I " a cT" -


. rP.fel4*iWQ,# 4,, dlinq w41h .Zol u.... .
ah tS akcoholiem Seduthat in eekoolt shudM be dveloped
he physical e involved, the social effects of alcoholism,
_which ainoo mvr rodues adh ptp .. .t. O


oh.... 4 ... their att i. needed so that the iwe.w

.. b : ) :.. .' .2 ..,. : ..
4 ; ': ". : .... .


.. : -2:' M a


1 by


W. L _


r ..-


...* ."::: .... .. .. "


,on






60

the curriculum, and to be familiar with other resources available to *aiwtbldo4nt
with a drinking problem within the scope of a federal Indian alcoholism gm
so that the student will be provided with the help he needs. ,- r ,i|
2. A phased approach to public education should be developed ad an sawam-
campaign initiated which would include all the communications meidisa bsfane
workshops, lectures, etc. Special programs could be set up for isolated gAatuuih,
as prisoners, and those living in isolated communities. Alcohol abuse .prI l
should be available to take part in panels, seminars, and workshops. itre
should be made available to the public and to specific groups and o9i-
Displays can be developed for libraries, schools, public and profesional mues,
etc. Special training courses should be developed to orient key .pUI n tA
community. Every worker in alcoholism with proper training oetldn deot sav#
as an information officer. Local communication smedia might be pecsuadewtto
donate air time to the discussion of alcohol use a4d misuse. Articles imtha lJal
newspapers and magazines could be used as another communications vealuoiby.;
the alcohol program staff. A public education program should focus on the 'natme
of the illness and its magnitude; the physical, psychological, and sehtpeets
of alcohol use; and the concept of alcoholism as a treatable disease; as well a ti
resources available to the alcoholic and his family. .. i
3. A comprehensive program should include development of oieutta*=i aid-
training materials and administration of individually tailored trainingflbgrafns
designed to meet the special needs of professionals involvpd.in each of t4lefoIlow-
ing: (a) Medicine and the allied health fields; (b) Education and counseling;
(c) Religious organizations; (d) Business and industry; (e) Law ant protective
agencies, juvenile probation; and detention centers, etc.; and (f) Federal1, :tat
and local governments.
B. Research and Development i P
1. The effectiveness of alternative treatment procedures should be assessed4",,
2. New programs should be developed in cooperation with other agencies,
3. The effectiveness of education programs should be assessed. yj ,
C. Community services provision based on the-principles of Indian self-dteflai.ho
and decentralization of federal advdniitrae responsibilities *:. : :2 t
1. A broad program of educational and referral activities using existi l leoth
care programs should be conducted. 7A
2. Active involvement of tribal leaders and the entire community in attdbdlfitl
policy setting, etc. is also necessary. Involvement of tribal leaders and thtitehlOh
community in alcoholism policy setting, etc. is almost nil on many reservatiohs.
Now is an opportune time to recognize how potent a mechanism the tribal htlth
boards and advisory committees have become for providing a high. dAei'
Indian involvement in their health delivery system.
3. Employment counseling and law enforcement agencies should tai: bin-
volved in the program.
III. TREATMENT SERVICES AND STANDARD OF TREATMENT' ", :
A. General hospital care ...
1. Policy and procedures should be established' for emergency treatment of
acute/chronic alcoholism as well as evaluation and treatment of eencument
medical problems both alcohol and alcohol-related, e.g., D.T.'s, cirrhosisL, uaua,
diabetes and hypertension.
2. Routine diagnostic X-rays and lab tests of alcoholics where clinically in-
dicated to determine if complications are present. .. ,
3. Staff orientation and development of in-service training to itdudeu itaf
attitudinal training and sensitization to the alcoholic patient should ad. be
provided. o ;
B. Out patient clinical care ,
1. Policy and procedures should be established for treatment of alcoholism on
an out-patient basis, and to establish non-medical detoxification guidelines as
well as supervision of short-term medication where indicated. 1:
2. Referral services, therapy, etc. using other local/state and federal .program
resources should be provided.
3. Training courses for staff should be established. .
C. Detoxification centers
1. Treatment and assessment policies and procedures should be estaiblished.
2. Programs for referrals from police, court, probation agencies and other
institutions should also be established.






41


I4i::!1 *St11IMtM Wtfon development and in-service training should be provided.
f4.o tlbt l o4n hiflims witl other health care and sodial services pro-
rmzlmSoWi'be set up and operational.
'"In:'" ., a" W E, ABILITATION AND FOLLOW-UP SERVICES
Agt *1Won of rehabilitation services
jglib'am should be set up on an individual, group, or family
thoe with alcohol abuse problems to talk their problems out. Other
*6Oties should also be provided as required. Trained workers are
'patients discuss rather than conceC drinking problems. As the
..so. r.lty, they must be discouraged from making haty or unsound
they are physically and emotionally well. Alcoholism retards
........ Wi.th sobriety and continuing recovery, the maturation process
-sffive sobriety and recovery depends upon the quality of the
tiax c ti i r iid an alcoholic receives.
i br. -eg s Should be set up with other federal, state, and local govern.
mept apancies to provide job training and employment services. A joint federal-
~i~a rehabilitation program for alcoholics offers a resource for the
!^||d xpupawion of diagnostic and evaluative services for the alcoholic
cnktinug on-the-job medical and psychiatric treatment; vocational
*frfo& b puaced tt and follow up; prevocational, personal adjustment and
4 r training; and many other services aimed at enabling him to secure and
......ltale employment.
stilsm ent of Indian oriented A.A. groups, Alanon groups, and
s. anuinar programs should be encouraged. These groups have
4iderble success in helping the alcoholic and his family to overcome
Aos. These groups need to be tailored to meet the needs of the
'J.^matibn centers should be set up under the sponsorship of coin-
:! plsux councils. Such centers can be run by volunteers or by one or
stat (s) if resources are available. The center can provide accurate
j.f..,a!chol and its effects to all who seek it as well as serving as an
||:lurce on the services available in the community to the alcoholic
P. The center could provide library services, lectures, telephone
e or other services as needed and should be integrated into a compre-
...olism program,
r housesQuld be set up where the need for them exists. In a compre-
..i.... program, there is a real need to bridge the gap between medical
p St ti~~o pal are and normal community living. An Indian half-way house
ca provide an Indian alcoholic with an opportunity to start over again in an
at&phere conducive to continuing abstinence and recovery. They can be
offeo-f6tive n alcoholism rehabilitation if they include a professionally
O-grecovery program designed to meet the needs of the Indian people and
nsMitewi part of a referral system with other medical treatment facilities. The
federal government can assist the Indian community to train staff; organize
tal health, counseling and educational programs; and in effectively utilizing
ind state employment and training resources as well as medical services as
5ifiemprehemive alcoholism program should also help set up and encourage
l i from caurt and probation programs to deal with criminal and juvenile
9 l wixth iMeSohol abuse problems. Courts and probation departments and
l4h01e4 ae uniquely fitted to contribute to an alcoholism program. Judges,
tea, and' pobation oimcers working in cooperation with a federal alco-
h6 program can require in Indian offender in lieu of a fine or jail Aentence to
k..n, tohoium treatannt program and thereby help stem the
Oog d(C sr itnation that exists for many alcoholics and crt through a
tailcredtor thekneeds of the In.&= community.
H uyed t betbliehs'hedltilnmatal and other specialised hospitals
T Ynin withM alcohol abuse problems who suffer from
ez hslorai, dlbeorler should be able to receive treatment in the
.ti-iqitlhhl pd8. Agrtsnemta between these imsitutions and the
fl 0vetenft neittdibe' established to facilitate such referrals and to
vde the Indian patient with easy access to the oare hbe requires.
S& Prison programs also need to be set up in cooperation with BIA for Indian
prisoners with alcohol abuse problems. Indian alcoholics who committed felonies
or other indictable offenses, if transferred to a federal treatment center operating


7T--46-76----6






62


within the prison, can participate in an intensive recovery program prior to tJheir
release and could receive follow-up services as needed upon their release. ,
B. Provision of followup services ..
1. The alcoholism registry could be used to provide followup services to those
who have received treatment for alcohol abuse problems. Such services would vary
in their nature depending upon the needs of the individual.
2. The involvement of those whose problems has been arrested in alpohq pre-
vention, treatment and rehabilitation programs should be encouraged, iough
it is essential to fill all positions with people having the best qualifications, If
addition to every basic requirement sought, it is also possible to add tbhe experience
of a recovered alcoholic who has achieved stability through recovery then an
added bonus and capacity is brought to that position. Recovered alcoholics can
also serve as volunteers in operating information centers and in other preve.ta-t
tive, treatment, and rehabilitative programs. The success of A.A. is proof that
recovered alcoholics have much to contribute to an alcoholism program. ,
I. VETERANS ADMINISTRATION STUDY ON FEASIBILITY OF COMBINED ALCOHOLISM
AND DRUG TREATMENT PROGRAM
The Pilot Alcohol and Drug Abuse Treatment (PADAT) Project 1975-1976
Handbook on Evaluation of Treatment of Drug and Alcohol Dependent Patients.
Veteran's Administration-___---- Department of Medicine and Si;rgey.
PURPOSE OF PROJECT .
Traditionally, patients with primary alcohol abuse problems have been treated
in settings separate from those with patients who have primary drug abuse pr6b-
lems, however, because of the many similarities in abuse of such substances, some
authorities propose that similar causal mechanisms underlie some of those prob-
lems. If true, it should be possible to treat both individuals and either or both
abuse problems in a combined setting. In addition to a conceptual justification
for integrated treatment settings could also be more cost effective in terms of per-
sonnel and resources. Better utilization of single-settings programs might be
achieved if admission were open to both types of patients, providing it was not
detrimental to patient recovery. Also, communities without sufficient clieht
population to support the establishment of separate treatment facilities could
still address both problem areas with a smaller combined treatment approach;:
PADAT is designed to determine the feasibility and to assess the effectiveness
of treating drug and alcohol dependent patients in the same setting. Results of this
project could have great implication for planning the treatment of these two
groups of patients which contribute large populations to V.A. honitals.
J. THE ALCOHOLISM REPORT, VOL. IV, No. 10, MARCH 12, 1976
The House passed and sent to President Ford legislation (S-2107) establishing
a new Office of Drug Abuse Policy in the White House and extending through
FY-78 the state formula and project grant program authorities of the National
Institute on Drug Abuse (NIDA).
The new White House Office would replace the Special Action Office on Drug
Abuse Prevention (SAODAP), whose statutory life expired last June 30. A Whte
House task force's "White Paper" on drug abuse recommended last fall creation
of a Cabinet Committee on Drug Abuse Prevention as a replacement for SAODAP,
but framers of the legislation wanted a White House Office for visibility alId
clout. It would have an annual authorization of $2 million through FY--78.
K. EXCERPT FROM REPORT OF THE COMMITTEE ON INTERIOR AND INSULAR ArrFAs,
UNITED STATES SENATE ON S. 522, MAY 13, 1975
Prior to fiscal year 1971, no Federal monies were spent on Indian alcohol wro-
grams. With the President's message on the American Indians in July 197, .$10
million was allocated from several departments and agencies to support Indian
health initiatives to develop needed special programs. Among these monies,
$1.2 million were pledged from the National Institute of Mental Health (NIMH).
None of these monies were actually transferred to, the Indian Health Service.
Nevertheless, in fiscal year 1971 interagency cooperation was affected and 39
alcoholism projects were funded by both the OEO and the NIMH under the
leadership of the Indian Health Service.
















tU.M S alcoholism programs would strongly suggest the need to increase
i im ad totransfer them to the Indian Health Service. The immediate
ea o. both the NIAAA and the IHS and of the Indian communities is what
pntq ..t .stin Indian alcoholism programs beyond their July 1975 termina-
. I~~ Iwg-term concerns are set out below:
i r present policy of the Department of Health, Education, and Welfare,
49ulDi on Aldohol Abuse, and Alcoholism, Indian programs are
U fl ~1 demonstration purposes only. This interpretation is based on
14WjW iedp of NIAA projects, which is "to conduct demon-
i Ie and evaluation projects" (P.L. 93-282, Section 111). During
t| te Senat Subcommittee on Alcoholism and Narcotics in March
E a offih7ls explained their interpretation of this phrase. Dr.
etEt Iiretor of NIAAA, stated that "there was never an under-
.tM e li Depiatment that support from the funds provided through
hlliw 91-616 would be an ongoing commitment in all categories of project
101 IP. John &. Zap, Deputy Assistant Secretary for Legislation
tM"!A MI Vt of Health, Education, and Welfare, said, "At this point
oeinent is saying the usefulness and purpose and validity of
iob has been demonstrated, and we feel it is now- you (the local oom-
.t.Senatsr Edward M. Kennedy dated August 8, 1974, Dr. Chafetz
.4lll,. position, but did recognize the need for an ongoing responsibility
C --'iw m s ny'position that continued support of time-limited projects
port
S"not ~an ongoing commitment of this Federal agency under present
v authority, I alsoreognise that there are some programs, which for a
. jt rea wll not be able to procure non-Federal support upon the
j r r project period, and that the Federal government does have a
lii thw ontinuation.
e Government has a trust responsibility to provide for the health
wlAerJn Indians, and the Indian Health Service is the agency having the
wqopaiblity for Indian Health care. Yet, the Committee has discovered
ji *s- IH pany other federal agency is legally obligated to provide
cUsm services; no existing statute makes this specific requirement.
E m 9I1-616, as amended by P.L. 93-282, does not authorize funds specifi-
bi diona s; in fact, the law does not even mention Indians. Thus, legally,
reve a poion of NIAAA funds because of their status as U.S. citizens,
uqt oth statuss as dia. The decision to allocate a portion of
S bIndian prt s and to establish an Indian desk within
.he ad"inis dW.atio fo these programs was purely discretion-
r e;Vith Vtttepakuarantee that alcoholism monies will be
or Itds nor indicates that the Federal Government has any respon-
p e aoholism programs eor Indians.
nb-o ._.. t Co. to place a specio responsibility on the IRS
treatment of aleohollsm among Indians, no
M tZt_.,91"tS OnVUdSWltprogam Wfoat the control jand treatment
=8Thhts ation A w i described In the March 1974 GAO Study,
i ,olMh1h u him nM& sHdb 1Servies'to Indian:s:
tIS, SlIo a prbably adversely affects more aspects of
1611 ay other hlW&-ath iatr aAnd has been an Indian health problem
M .i64lfnat)VlB nbrt tatalobism irhois dishategiates
y relaand aely affects the economic functioning of the whole
H ba"4 l saasuts anad suicide attempts are
e with drinking....OaaMeht a significant part of their






64

medical services workload can be traced to alcohol abuse and alcoholism. How-
ever, IHS has done little to explore the nature of extent of, and solution tr the
alcohol problem in most Indian communities.....
We have found that, although IHS provided medical treatment to alcoholics,
almost all the funds for projects to prevent drinking problems or rehabilt"at
alcoholics were provided by Office of Economic Opportunity until July 1972 i4
thereafter by HEW's National Institute on Alcohol Abuse and Alcoholiqm. &,:. :
IHS headquarters and service unit officials said they had little d-t.aon .* e
magnitude of community alcoholism and had no data on how effctivy the
projects were dealing with the alcohol problem. IHS officials believed tiese
programs, for the most part, to be incomplete, fragmentary, and lacking sub-
stantial impact on the problem. ..
!! I ^ "t .!*.>.] "
TESTIMONY-ANCHORAGE, ALASKA, APRIL 26, 1976 ",
Summary and main points of each speaker
Daisy May Lamont, Bethel Community Health Representative: fnaiudes
57 Villages in the Bethel Area.
In Bethel itself, 90% of population is Native. "Alcohol and drug abuse 'As; the
highest and top priority problem we have." The population at Bethel is ap proxi-
mately 3,000 and about 70-80% of population have alcohol problems. There M
presently nine people working the alcoholism program of the city council. The wain
problem is no finance which is necessary for the program to expand. There is 6a
need for more staff training and more facilities. The facilities available now are a
sleep-off center and the PHS hospital. A half-way house is needed; more help, is
needed in the villages where there are few, if any, resources. "There is high
percentage of marijuana in young people." .
Trefon Angason, President of South Naknek Village Council and Corporation.
South Naknek is approximately 70% Eskimo. "In our village, we have a potef-
tial alcohol problem of up to 90%." Alcoholism facilities are needed. South Naknek
has a population of approximately 175 people in the wintertime and about 2500
people in the summertime. "We don't have year-round employment, and' as a
result, there is nothing to do but sit there and draw your welfare and drink."
There are 29 villages in Briston Bay and South Naknek is only one of the villages.
It does not have any form of services. There are some services in Bethel, the center
of the region, but in many of the villages, such as South Naknek, there just isn't
anything.
Cyrus Peck, Jr.,-Juneau Area Alcoholism Counselor.
In Juneau, there is a treatment facility which is white-oriented and la titi
center. The crisis center program was cut back and as a result, there is diffildty
in getting the alcoholic to the treatment center; lack of transportation is the main
problem.
Education of children is very important, as well as getting the community
involved in problems of alcoholism. The population of Juneau is approximately
17,000. There aren't any alcoholism facilities in Juneau which are run by orgeardet
to Natives. "There's no effort being made to understand the culture, the (Nativ$)
people." :
Suimeon Arnikan, Rural Cultural Specialist, National Council and Alcoholism,
Alaska Region. .
Western culture is taking over and destroying the Native cultures. "M y
minds of Yupik, Eskimo are now filled with new ideas, and the effects of these nie*
ideas will both harm and benefit the central Yupik Eskimo. The effects of alcohol
in the rural remote communities of Alaska need to be passed on in the form. f
information, education and prevention."
Fred Pete, Associated Village Council Presidents, Bethel Area.
There is only one alcoholism program in Bethel and none in the 57 villages in
the area. There are 5,000 people in the area and they are spread out in an area of
about 100,000 square miles, with no drug abuse program in the area.
Mary Jane Brower, President of Alaska Federation Native Youth Council
amd Representative of Artic Scope Regional Corporation.
Alcohol abuse is caused by lack of self-esteem and being taught white history
in school. Native youth should be taught native subjects and be proud of who they
are.
Gordon Jackson, Executive Vice-President of the Alaska Federation of Natives,
is President of the Rural Alaska Community Program.






66


i gave a brief introduction and history of the Alaska Federation of
,was organized in 1966, primarily to seek a fair and just settlement
Native Land Claims Settlement Act.
d alcoholism as the number one health, problem of the Alaskan
Lg that "it takes away millions of manhours from not only the
rations, the construction of the Trans-Alaska pipeline, and other
projects throughout the State of Alaska; it takes away our loved ones
increases our crime substantially throughout the whole State of
Native population of Alaska is approximately 75,000.


Coordinator


for the


Alaska Native Human Services


W nth e health affairs of the AFN, the fundamental goals and values of
Ia N4tive family have not been provided for the youth. "Drinking to
k eas the norm." "Figures from the Alaskan Department of Health and
E8, Statistical Services and Office of System Development, Alaskk
m NaMte~. Islth Services states that the 1960 death rate attributed to alcohol-
was 4.7. per 100,000, and the rate in 1970 has risen to 41.4% per 100,000.
ae"uMimwepnt in 1970 was 57.4 per 100,000. The related problems of alcohol
T a been observed to overwhelming and incapacitate entire village popula-
ttgan bt t least two occasions in the past year." "The total number of deaths
ilf lijg alcohol would amount to over 50% of all deaths among the Alaska
N population and 18% among non-Natives. Alcohol can therefore be con-
imid t leader among specific causes of deaths in Alaska." Since much of the
treamet of alcoholism is conduced by alcoholism treatment centers, sleep-off
Qttl tw., the medical care system is not fully aware of the burden of this ill-
Aj W 4eention and treatment facilities exist to deal with youth. Alcohol
d eeducation in the schools is both sporadic and limited. Services
i rural areas and villages; a tracking mechanism is necessary within

k tmaNus, Alaka Native Special Alcoholism Project, North Pacific Rim
J... Alaska are taken from their village when they are brought in
eni -They go to an urban setting which further complicates treating
the p o llcohomism treatment in Alaska is done in a non-Indian way; no
Sp.itn i. given to the cultural identity of the person being treated.
S eter. Outreach Counselor on Alcoholism for Episcopal Diocese of Alaska.
ldioliSt problem should be attacked by all agencies, institutions and
w*b t maximum effort possible, and everyone should be educated about
.....a e is very widespread. More training of counselors and community
9a.. is needed.
Ber, Alaska Native Commission on Alcohol and Drug Abuse.
la.n a estimated 16,000 alcoholics. A decentralization of, alcoholism
is needed so that people can receive treatment without leaving their
hon muity. Training should be a number one priority and should be done
topialy because of the differences between regions.
.trar Nicholi, Copper River Native Association Counselor.
a pi served: 300-400 Athabascan. The people with decision-making
b ahim programs, do not know anything about alcoholism.
S:. .akan, Project Director of Hope Center, Dotzebue, Member. of
edspf the regions differ in the villages. Some of the villages needWeducatiop
I kternatives. More family counseling is needed in most places. We need to.
S a priority the reestablishment of cultural values. Population of
'apjidatel 4,500, 95% Eskimo. Alcoholism is the number -ne social
6CooMNic problem, meatalproblem. The PHStreats some of the alcohol-
e" but the moity oft their oames really are alcohol-related and
a*" e addresd amsuhTreatment needs to be localiseL -I
oise nr, Regional Technical Assistant for the Mauneluk -Association,"
4ttitud Wq important In dealing with alcoholism--the attitudes of the people
t. tt it d the .peop who o or do not drink Getting the- community
tl is v lmputa Aoommnty enter isntded.
- sai t.in, President sad Sueotetive Director of Cobk Inlet Native
A .... .i w.ti '..1 ^ ,, : 4 ..jj.. ".. .:.'..#' !.....-. .... ,- .
I n *i .; .. h :' * * . r i : s t i -/ ; ** : i : r .'- . m . iI






66

Represents approximately 15,000 Natives of various nationalities in Anchorage.
In Anchorage, there are ten alcoholism centers but none of them have any NatMA
on the staff or included Natives in the preplanning of programs. "There is$l,9300-
000 spent in Anchorage alone on alcoholism without any Native inu into the
program." However, the numbers of native people are always submitted ae
justification for the money.
Ralph Emarok, Rural Technical Assistant for the Aleut League.
More alcoholism assistance is needed on the Aleut Chain. There are apprimately
1,900 Aleuts on the Chain, and there are insufficient alcoholism programs. Te
people on the Chain make up only 3% of the Native population so they are often
overlooked. I
Teresa Devlin, Alaska Federation of Natives, Human Science Department.
More pamphlets and brochures should be tailored to the village level. More
emphasis should be placed on the village in controlling alcoholism. The medical
profession is very limited in its knowledge of alcoholism. For the most part, they
do not want to be bothered with it and provide very little help to the alcoholic.
TESTIMONY TO ALCOHOLISM AND DRUG ABUSE TASK FORCE NO. 11, PHOENIX, ABRI.?
MAY 14, 1976
Summary of main points by each speaker:
Richard Curry, Director Alcoholism and Drug Program for the Ute Indian
Tribe
"We need complete and total coordination of all human resources that are
available". There must be some written affiliation agreement stating what each
agency will perform for the other and how their coordination will take place.
There are six categories of need for an alcoholism program: (1) education and
prevention, both for the general public and for youth; (2) detoxification; (3)
treatment; (4) rehabilitation; (5) follow-up and support; and (6) personnel train-
ing. A detoxification center should have a medical staff person and have the
client stay three to five days. Treatment and rehabilitation should be separate
because rehabilitation is a later stage and clients will be doing different things than
in the treatment phase. Personnel training should be done locally if possible.
Needed are facilities, personnel, training and guidelines.
On the transfer of alcohol programs from NIAAA to IHS: (1) there should be an
orderly transfer; (2) programs should have input as to how and when to transfer;
(3) programs should have input to IHS organizational setup; (4) programs be
separate entities under IHS under supervision of the local supervision directors
(5) all employees must be knowledgable in the field of Indian alcoholism and
drugs; (6) programs should have more input in the selection of key personnel;
(7) programs be set in a priority; (8) money be available to programs for up-
grading and expanding; (9) the present autonomy of the program will not be
changed.
The Ute Tribe has 1,629 enrolled members; approximately 2,500 Indians.
Rick Harrison, Director, Alcohol Program at Southwestern Indian Poly-
technique Institute, Albuquerque, N. Mex.
There should be more emphasis in education and prevention. "The use of al-
cohol and other drugs by students has been a major deterrent to their fulfillment
of educational goals and position attainment and retention." Public awareness
meetings with people in the community are a good idea-awareness is necessary.
But education is more than that. "We need to have people grow up with it (knowl-
edge about alcohol and drugs.)"
Ron Moore, Director of the Hopi Action Program in Oraibi, Ariz.
Total population on the reservation: 85 to 9,500. In 1975, there were 1,628
arrests of which 72% were directly related to alcohol. There were 144 juvenile
arrests and 80% of those were alcohol related. There are also some arrests for
sniffing and marijuana.
Our program focuses on five areas: (1) individual counseling; (2) group counsel-
ing; (3) youth prevention; (4) community education; (5) referral systems.
We need detoxification services, Indian Health Service provides it at times, but
the agreement with them is too loose and they often don't have the time or room.
We need a more formal agreement with them and with the law enforce-
ment agencies.
There are six people in our program. Presently we are working with 82 in-
dividual clients, all of the school population with the Community Education






67


Ii- various community groups, and the court sobriety program of incar-
Speople working in groups. We have no treatment facility. Counseling is
I u done in a home or a shared community building.
AN. we needs to be more coordination of the various agencies providing alcoholism
sev s and various funding sources. Ideally, there should be a single funding for
Indian programs. Some consideration should be given to the problems of isolated
oommrnnites who are far away from services.
Sypikna McCabe, LEAP Department, Phoenix, Aria.
if"We need to have an improvement of relationships with and between the
goernmnatal agencies because the support of these agencies is necessary if a
recvery is to be achieved by the alcoholic." Population of Indians in Phoenix
rages between 16,000 to 20,000.
Education about alcohol is essential not only in prevention, but to the people
whe are giving services . from the Community Health Representative to the
feral people who are major Indian employers.
Joe Hayes, Director Indian Alcoholism Program, Phoenix, Aria.
"Guidelines for operating the Native American Program should be written by
th Natte Americans who are involved in the day to day running of a program...
The need for cultural identity is of major importance and should be used as a
helping hand for the residents."
-~ A.ui Director, Cocopah Alcoholism Program
We need a detoxification unit. There needs to be a formal agreement with IH8
or a& loal facility of our own.
"Al : attitude of the state people is not what it should be towards the Indian
opuramzs . *They are ready to drop them if they don't comply with require-
meats," i
Alcoholism and drug programs should be combined so that funds and other
remouums wouldd be pooled.
The community needs to be educated about alcoholism services. Education
4is61miuporant phase of the program.
,^41#h* Kitcheyam, Chairman, San Carlos Apache Tribe
i^^^tely^ 7,000 in the tribe.
a :!' main problem is with funding. The San Carlos Tribe has made a number
of 0 rpsa-and has received encouragement but very little in terms of funds."
Te mjor problems on the reservation are alcohol-related. Many deaths are
M :st -a the training sessions for alcohol staff should be local. Having training
somewlmre far away from the community is not training the people to deal with
their ewwmmunity.
the last few weeks, a number of our high school students have been arrested
Wo of marijuana.
: 2 ., :. :.. Burns, Alcoholism Consultant for IHS, Phoenix Office
iWhi" Indian Health Service has historically accorded to alcoholism the
distinction of being its number one health problem, it has not heretofore been
eImwlb*1 resources and money and manpower by Congress to deal effectively
tMl .1 . As a practical result of this historical problem, IHS Hospital staff
M.4eat with alcoholism principally as a side issue in the provision of acute,
mdi.al care to those requesting such care. It has succeeded in placing the major
buenw for change into tribal programs which were ill prepared to cope with the
p..y of required mental and social services that are part of the total alco-
holism program. As a result, tribal programs have insulated themselves so that
tejpan operate without much interagency support. With us impending transfer
ttCJ, new avenme of communications must be opened."
'".. A standard reporting system needs to be worked out IRS and Indian
aloolism programs must work together to determine methods for selecting data.
litee fr much to be done in the organisation development and implementation
of a joint Health Service-Indian Alcoholism Program.
* Recemmaedations include: (1) Congressional fiscal support to IHS over and
above the amount to be allocated for diret alcohol program support and sufficient
a Iplemt a fufter akoholism program; (2) commitment for funding of health
education activities directly related to alcohonsm and which would pwviwde
arf support ttribel acitivities in the same lUne. (8) Commitment of funding to






68

to the development of alternatives to problem drinking behavior in yowthnh
as therapeutic recreation programs. i v
IHS should definitely get into the preventative program area. [C: '9:
Rachael Mike, Alcoholism Prevention and Education Program, ?Puakr,
Ariz.; Colorado River Indian Tribes
One of our problems is staff turnover. We can't afford to pay people to stay
with the program.
Another program is IHS doctors who refuse to deal with alcoholism. The doctors
should be told that they will have to deal with it if they are going to work.with
IHS and if they don't want to, they should not work for IHS. The doctors haven't
had much training in alcoholism treatment and detoxification, even if they wanted
to help.
TESTIMONY TO ALCOHOLISM AND DRUG ABUSE TASK FORCE NO. 11, BUFFALO, W.Y,
MAY 7, 1976 ....
Summary of Main Points by Speaker:
John Ginnish, Director of Community Service with Boston Indian Council
Out of 3,500 Indians in Boston, 400 to 800 suffer from alcoholism. Indirectly
or directly, alcoholism affects nearly 80% of our people.
In 1974, 21 Native Americans died in Boston from alcohol-related causes.
About 90% of our court cases are alcohol-related. In addition to alcoholism, many
of these suffer related serious health problems.
At present, we have an alcoholism program that attempts to provide the
alcoholic with a sense of pride in his past and an understanding of his present
condition. The approach works well but the project has no facilities, of its own
and works out of Boston Indian Council offices. This is an inconvenient place
for most clients to reach and we have transportation problems. ...
The State Division of Alcoholism does not consult or consider us. The response
of the. state has been that they already fund alcoholism agencies that we can
utilize. But past experience with our clients indicates that Indian alSoholies
are very reluctant to use non-Indian alcoholism agencies. Nearly 80% of our
people are not members of federally-recognized tribes and are therefore denied
services by BIA and IHS. The federal government and funding agencies like
NIAAA should put pressure on the states to adequately provide funding for
urban and non-recognized tribes.
Rancho, Executive Director, Maine Indian Alcoholism Program
The. program comprises three state Indian reservations and two off-reservation
Indian groups, approximately 4,000 people. Contract has been terminated be-
cause we could not pay for medical services under Title 20. We could not use
the (Medicare and Medicaid) funds because it is restricted (Title XX) in facilities
that receive Title 19 funds. Nearly all medical facilities receive Title 19 so :that
restriction should be done away with. Our biggest problem is no medical services.
We find that they are badly needed and we get very little cooperation with Maine
hospitals. We provide other types of service but the medical service is critical
and we aren't able to provide it now. : .
We have found that there is a special need for family counseling. Our counselors
have to do much more than work with the individual client. They have to provide
service to the whole family. There is a lack of adequate suitable records on Indiasi
individuals. Sometimes they go from one doctor or facility to another and receive
medication in each so that they are getting more drugs than they should.
There is an unemployment rate of 80% among the clients we serve. We need
funds to expand our employment program.
The bureaucratic and administrative reporting system of NIAAA is not reall6
giving an accurate picture of our program. It's taking too much time away from
the counselors for administration.
Mary Bighorse, Coordinator, Community House for Alcoholism and Abuse
Service, New York City
For the first six years we served only as a community center. Now with grants
from CETA and Office of Native American Programs, we have developed into a
multi-service organization including counseling, employment service, cultural
programs and social service referral ...
SOur. service population tends to be -.transient for the most part . Chronic
unemployment and cultural disintegration are some of the most serious problems.






09

Me bo mbinstlon of almost 80 tribal groups from North, Central and South
Aerica wth relatively small representation of each creates & problem in the
dtTwy of services. Many Indians here are non-federally and non-state recognized
so their problems go unmet. In a two-month period, our community services
program found that housing, counseling alcoholism problems, health care and
emergency aid were, in that order, the five primary requests for service.
Presently, we use New York hospitals for detox and low cost hotels for the
Nomac Geoehollo. We need a separate facility for Indian men and women who
are in the fihnl months of sobriety. Just being together with our people is one of
t* gi important phases of recovery. Residency is necessary for follow-up
We have a difficult time getting people into Public Health Service. Transporta-
tion is another.
Miy ShidM", Community COBTA Support Service Deparment
We have found a need for a facility in which to house people that have alcoholism
n Ouethbrd of our CETA participants have a problem with alcohol.
AwsIoo as our client gets off the seven-day detox, we try to get him a job right
sway. Ib works for us.
Marilyn Anderaon, Social Service Counselor for the Seneca Nation
Oat m.ay case load of about 60 families, at least 40 are affected by alcoholism
or drug abuse.
:S m.of the problems we have are: services are unavailable in the evening;
-there is not much for juveniles; lack of Indians with training; agencies don't
relate to the Indians.
Idia people should be represented more in agencies that they work in.
Anna Devlin, American Indian Services in Detroit, Mich.
mated Native American population of Detroit: 5,000.
u. our NIAAA funding we believe many positive steps have been taken
PC: substance abuse services for Native Americans in our urban area.
E IsT criu t al need for the continuation of these services.
TWe migration from reservations to our urban area causes many problems
which contribute to the high rate of alcoholism. State, county and city programs
-AM a in such a way that it makes it difficult for a Native American to enter
5 .2 Special Native American Plogram is needed which can also serve as a
.ao with other social services.
..A. .can tork if it's geared to Indians, but we have other alternatives.
Me. d Boteni Vin urry and Barney Waterman, Alcolism Program with
theSeneca Nation, Salamanca, N.Y.
... eed staslf-way house in our area. Without a place to stay, people go back
$od klng and the drinking environment.
Marijuana is getting as bad as alcohol with the kids now. We need to start
"0kg care of the young people.
I Ptea HiU, Tnawsnda Beseca Indian
The members chosen for the American Indian Policy Review Comnmission
-coma 4com the western United States ... I don't know any of these people.
Sdin't represent me ... you can become a billionaire on Indian problems.
Sdoen't help Indians. The federal government wastes money. The agencies
,lthe federal government sends money to for helping Indians don't do any-
M6..We -don't need those agencies.
f9n Abfs, Chf, Seneca Council
For the record, Miss Hill's statements are not with the views of the Tonawanda-
&secWmflbel Counoil.
. 1 7..AI S, OKLAHOMA CITY, OKLA., MAT 1, 19I
Jmmmarvpsd main points regarding alcoholism:
R9WoMw. Wd44 llwcukwe Director, American India Nurse Aaaociadian
Sand Assistant Professor at University of Oklahoma
"Nonecf us (health profeonals) had adequate training in the area of workT
with alcohol amo1g American Indian people". In many places, alcoholism is


77-466-T----T






70


approached moralistically or legally rather than as a medical probleat 'MWny
times IHS refuses to handle alcoholism or doesn't know how to deal with it. .
Alcoholism is caused by anxiety and difficulties in living which comes from
having to live in a prejudicial society.
Bob Gardner
As stated on the intake forms for Indian inmates in the Oklahoma penal system,
approximately 94% of the Indians going into criminal institutions state that they
were drunk at the time they committed the crime they were convicted of. i 11.
Alcoholism is an enormous problem-there is a large area to cover, and many
people to help. It will take a great deal of money to even bring the problem to am
acceptable level.
Dudley Whitehorn, Osage Tribe ''
We need more drug programs slanted toward education. "In Osage country, we
do have a drug problem. Drug education needs to start in kindergarten.. Children
should be taught self-worth and be educated about drugs. There is a lot of sniffing
at the Indian schools. I have seen very little done in the field of education, even in
alcohol. Most alcohol grants are written in for some alcohol education, but I
found when I worked in the program, my counselors were too busy to do much
educating."
Education about drugs and alcohol should be part of the school system. Young
people should have some voice in the policies and structure of juvenile programs.
A youth drug council and alcohol council should be set up. -
If a study were done, it would probably reveal that there is a greater need to work
with Indian people on drug abuse, especially young children in school.
Elaine Bennet, Drug Abuse Counsel Center and Human Ecology Programs,.
Lawton, Oklahoma. Paul Bennet, Human Ecology Learning Program,
Lawton, Okla.
"In our experience in working with Indian people as well as the white people
in our programs and through Indian schools, we seldom see strict alcohol or
strict other drug use. It is generally poly drugs. If you get a student or client
coming in who identifies himself as having an alcohol problem, you can just ms
well bet there is going to be another drug."
There needs to be programs dealing with all drugs, including alcohol. "
The Indian does not come forward readily to the white treatment' facility, t&
facilities should be available for just Indians. p'
Personnel and facilities should go to the community where they are needed
instead of having the people come to them. Outreach is necessary.
"The medical field is a failure as far as drug and alcohol treatment is concerned."
Dr. McClellan, Assistant Director for Program Management, IHS
"Alcoholism is not one of our (IHS) primary areas for service; NIAAA finds
the alcoholism program. We have not alcohol per se, we have mental health, but
not alcohol.
"Our physicians are beginning to be more sensitized to health problems which
are basically alcohol-related. They are recognizing alcoholism more and more."
John Davis, Area Director, Indian Health Service
Our health professionals sometimes do not accept alcoholism as the primary
diagnosis for an individual because the community as a whole does not accept it.
"I believe some limited steps . I guess I better put the emphasis on limited
. . are being made in this direction. I would think alcoholism problems and the
aged are areas that Indian Health Service and Bureau of Indian Affairs for too
many years have not addressed and we have neglected. We have a great area
of neglect.
Ralph Wermy, Dallas Tribal Center, Tribal Concern on Alcoholism Program
There are approximately 15,000 to 18,000 Indian people located in the Dallas
area. From 1973-74, the program served approximately 500 people who had
alcohol-related problems...
It was very difficult to receive funds or any assistance from the state because
they have assumed that the federal government was giving the Indian people the
funds to work with.
Most agencies do not accept alcoholism as a disease. The Tribal leaders and
people who must be reached to try and change their attitudes before getting to
the "grass roots"Jevel. The grass roots level now has accepted the disease of
alcoholism.






TI


OJuflj more personae! ad need to be able to have contact and referral with
S.d be6de by Indians bs0aTndkb already know what their

E4 TaGGan Chief of to Seminole Nation of Oklahoma Pridnt of Oklahoma
'dAA ) 'tlmia ksw. AdvAiory fd WmW s PofriFdB ofOkah
The problem of alcoholism haw't been discussed too much ln'ott area. It should
Sfr giLf bUt we haven't had bodyoy on that board that is very well versed in
at fEdrMWerecognise it. It ranks high priority in our tribes.
,.r. JM iBckl Director .f Comwmunity&. Serv for Ue OCrek Nation of
:.A eir* -was: taken by the Community Services Committee indicating major
suds and recommendations. Excerpts about alcoholism are as follows: An intense
C tio iiMgram (about alcoholism) is necessary for all levels and ages with a
Iatual approach to avoid the escape vehicle of choosing sides with an excuse by
tten 0Gi8%wt.Mbsae .a progm_ r21m judgmental in that particular case.
E. kt le o ntselling and rehab'lt4ttve programs are needed to deal with
iMa&di a ther drugs. Though alcohol is legal, many Indian people need to be
ught tonomply with the necessary legal restrictions.
' 'lbOththalf, of the alcoholics come from a family where one or both
as are alcoholics, it is absolutely essential that some of the root causative
tt attacked positively through and by. use of active program people, by
361Db isio providing agencies with a unified effort to accomplish its goals.
b41t q'rsh..ar. Director of the Inter-Tribal Alcoholism Program
m Gstpmami needs stability. Some kind of national standards and certification
bn -hi -program credibility. We lack credibility.
J1 Wba tmore community education now and most programs are craisis-oriented.
The ed Is so great and the programs are usually so understaffed and funded
SW % oQ'ttt get tie -to be involved in more educational activities.
Our pro ams serve, about 600 alcoholics a year There are approximately 9,000
iwi:i k aour five-county area that have alcoholism problems. We are just
uoeEtUgothei surface. We don't have the resources to support Indian community
T'l needs of women alcoholics are barely being recognized let alone being met.
In the whqlp state of Qklahgma for all programs Indian and non-Indian, there are
tMiA "programs that accept women. Women are reluctant to seek treatment
mifi .6 reasons: one of the most threatening is the fear of their children
41 1e1IWW and rput in fobiter homes.
44 kflbtm-needs to be recognized as the health problem it is. I think there
3ol )e mauy problems in combining alcoholism and drug treatment pro-
MeAloholecs are reluctant generally to come into programs with drug ad-
dits thea s an age difference between alcoholics and drug addicts. The
t i be tqd to be younger. The difference in age would make it difficult. There
ib a .treatment program set up especially for the young people.
. l ^l*": l.. : t .."' ..... ; : ;. i.. : " .: '.***
jA v. mlym T BPOna 'ASK YfOCR NO. 11, SAN DIEGO, CAZIF., MAY 9, 975W
M 10, i femain poiebypaer:
flk Hoof, Director, UEiWd Americak Indian Iselvemeent Crisi Walling
S Center, Los tngeles, Calif.
'My main concern is the fact that we have to rely on other agencies to provide
series. t oa clients. Thesw aeies are not Sensitive or receptive to-the Ameri-
can, Idian or his or her problems. UAL is not a rehabilitative program. We are
.Ii tej wvikaM and referral. That.z why I stress. we have to rely on other pro-
gras.... (Other programs) are not dealing with the cultural problems of
re .eif ble m the treatment approaches and cannot meet the
i`! 6Se. T11 n ash eeive d re i federal funding
Ie s itn % them to be:mor eribe thani" ity, county bf state funding would.
cui,f p eiuoit drinking patterns which is a very difficult thing to
6.Thlitsde people din theme aehad tier Tobhem; it's not a game and it's
not a form of enterta ent. It is a way of life and it's an acceptable way of life.
.J .MIt yu 51 wi te Wive, y.u 'fbave to ldrik to live down there. We
stress Inian ride inie ,Intjian culture: This is not the Indian way. And we
|^nfor~terfv^^^ever^ until t does tart, working.U its the
is W- o d ebh eeoun Snatchlng the pew! premsureof the Indiams on the
street. We're stronger and we last longer because wea-e sober and became we






7?

are setting examples. Because we can relate culturally to these peoplia Peeone
we can relate on a street level with these people.
Needs which have received little attention are: (1) a home for India 4110ren
whose parents have alcohol problems; (2) women alcoholics, especially pregnafA
women whose alcoholism may cause damage to the child.
George Baker, Coordinator, Native American Indian Project, Mu4i-Culural
Drug Abuse Prevention Resource Center
My recommendations are very strong that the Indian people determine the
state of the Indian people themselves. What program modalities that they wo*
in. What area they work with fits that specific Indian need.
As part of prevention, the education system particularly the boarding school
situation, needs to be revised to teach Indian culture.
We are finding more and more that there are numbers of drug problems that
are existing, primarily the inhaling problem with our Indian youth.
We're finding much more of what we call a poly drug use in the Indian cottre
on the Indian society.
Rachel Nabaha, Program Director, Intertribal Council of California, Inc.
There is a need for comprehensive alcoholism services among California's ruraA
Indian population.
The countries are not responsive to the needs of Indians, particularly the rural
counties.
The federal government should continue funding Indian alcoholism programs.
Each county with an identified Indian alcoholism program should be required
by mandate to develop comprehensive, long-range alcoholism plans in cooperation
with Indian programs. All costs for the comprehensive alcoholism plan be included
as line items in the annual county health budget and that distribution of these
monies for costs be through block grants directly from the state to the Indian
people. The formula for allocation of these monies be based on need and not
total population.
Documentation proves that the Indian people suffer disproportionately hi
incidents of alcoholism compared to the non-Indian population.
Additional money should be appropriated to provide more aggressive education
and prevention programs, specifically, programs geared to meet the needs'of our
youth.
Danny Vega, Leroy Hoof, UAII
Drug use is increasing in the Indian community. There's no feasible program
within the immediate L.A. area that meets the needs of Indians that have a dial
or poly chemical abuse problem. They're too short-term. There are not enoug
people involved that are willing to help them. There needs to be education to
make Indian people aware of the problem and to accept it.
In institutions in the State of California the Indian is classified as "other."
He has no direct percentage set aside for him to develop programs.
I recommend that Indian religious spiritual leaders be assigned to the clerical
staff of our large institutions throughout the United States and make it nmandatoay
for the betterment of our Indian people, for their spiritual youth enlightenment.
Also that alcoholism be treated on a medical and social level rather tUam on a
criminal level.
In central L.A. 1975 statistics show that 4,533 Indians were arrested in tt
central skid row area alone. There is a great need for direct services, detoxification
and half-way houses, not just referral and crisis intervention.
Dave Hostler, Hoopa Valley Tribe
There is a lack of awareness of the reservation population in California.
More Indians need to be represented on national level boards&
The agencies we have attempted to use, welfare and state rehabilitation have
been unresponsive to us.
Leo J. Camp, Director, Alcoholism Awareness Program, Youth Awarneap
Program and Turquoise Lodge, Sacramento Indian Center, Inc.
More emphasis should be placed on research alcohol treatment prevention,
education, health needs and spiritual needs because in our area, we have no
spiritual leader.
We need more money to run our programs and less red tape and bureaucracy
to deal with.
In a survey of school kids, out of 270 responses, alcohol was rated as the number
one drug; marijuana was second; and then poly drug use. There is a definite need
for more youth programs.






73

There is also a need for programs to prisoners.
Our response and support from other agencies has been limited. The Indian
community in Sacramento is not very responsive to alcoholism problems.
George G. EBffinan, Project Coordinator, Indian Alcoholism Commission of
California
I feel that the attitude of the whole Commission (AIPRC) towards alcoholism
has been very, very weak.
The need for Indian oriented alcoholism services goes far beyond the recognition
that alcoholism is a major health problem among the Indian people, but Cali-
fornia, with one of the largest alcoholism budgets of the nation, gives less than
token financial assistance to programs serving this population.
There is a great deal of red tape in dealing with the state. I recommend to
continue direct federal funding. Counties are simply not giving any of their local
funds to Indian service programs.
Recommendations: (1) increased appropriations to fill the need; (2) continua-
tion of direct funding for Indian programs; (3) that Indian programs be exempt
from public law 93-641.
Herb Coheen, Program Director, American Indian Development Lodge, El
Cajon, Calif.
I feel that one of our greatest needs at this point in time is to educate people
in the alcoholic recovery field so that they can go out and help other Indian
V&is both in counseling, administration, house management, at nine and a
half dozen areas.
Secondly, we need vocational rehabilitation programs. The state of California
has the resources.
Indian health services here in California are woefully inadequate and this is
certainly an area where we need support and improvement.
Cecilia I. Firethunder, Psych., Nurse, Youth Recreation
Alcoholism programs are dealing with a problem after the fact. What is needed
is sports and recreation for Indian youth. There are absolutely no monies allocated
for sports and recreation for Indians. There's no money for sports events because
the money's going to alcoholism and other programs.
Daniel M. Forest, Jr., Director Sundance Lodge
We need a comprehensive program-an overall program, working with families.
Indians should be able to use all the resources of all the governments: state,
federal, county and city.
Direct funding should be continued.
Earl Livermore, Director, Native American Alcoholism and Drug Abuse
Program, Oakland, Calif.
There needs to be an increased effort to see that the legal system deals with
alcoholism as a health problem. In order to treat alcoholism as a health problem,
we need additional health care services. Specifically, we need a residential center
to temporarily serve children of the alcoholic families.
A specific section on alcoholism should be part of the health professional's
training. We need funding for community education and prevention. The staff
of Indian centers should be trained to assist in the treatment of the problem.
In order to receive a fair share of funds, we need to try to stress more affirmative
action in getting Indian people hired on city, county and state governments.
Alcoholism programs should be exempt from Public Law 93-641.
The Veterans Administration should provide services which many Indians
are eligible for, but many of our people are not made aware of these services and
consequently, they are not being utilized.
Many Indian people do not utilize the services of existing health service agencies.
Indian people do not relate and are socially isolated much of the time.
As far as research is concerned, there should be Indian involvement and con-
trol on any research projects.
Willard C. Rove, Counselor, Friendship House for the American Indian,
San Francisco
We work through the Christian Reform Church. The Church owns all these
buildings and NIAAA funds the staff. The problem with working with the Church
is that it wants to make christians out of everyone forcibly. This is against the
Indian way. You can't force a man to be what he doesn't want to be.














a,















.2




























-.4




















SECTION IV
BIBLIOGRAPHY
L Articles from Periodicals, Annual and Newspapers
!L Books
IM Letters and Memorandums (Unpublished)
M.Pamphlets
V. Congressional Acts, Bills, and Supplementary Reports
VL Specud Reports
VIEL State Alcohol and Drug Abuse Plans
VIT AIPRC., Twk Force No. 11 In :rmal Hearings Transcripts
and Site Visit Testimony
EL I*Aers Received From Individuals, Progr.ams, and Tribal Rep-
reumtatives in Response to Questionnaire
























































































I











I. AmcLas Foxm PzmooCALs, ANxu&AL, NuwspAuna
_~thMr+ Nat n sad Golema, Danel, "Gambling and Fuactional Equivalent,"
VJoail sf'ludi on Acoboi, 30 (3A): 733-36, 1960.
E.* somParinmtg alcoholism mad gambling in various cultures. A Hypothesis of
mui'Sy s Sfdl o.tltures which show a high incidence of gambling show little
k k ad-M vice vMsLa. Over the pust 150 years the sht in Indian culture has
embblnMn guibling tooaleobisoUm due to cultural disruption.
Oft"a Md i Duy Problems Assmeciation of North America, "The Alcohol
tiv Review." V. 1, No. 3 & 4, May 10 & 22, 1976, Washington, D.C.
1-4 anvwilsltta recunuting current legislation pertaining to alcohol and drugs
Alcohol World: Health and Research, "Self-Help Programs: Indians and Native
A.4MM&AIS., 1i97s4, NrAAA.
baulml hlslty -of problems of alcohol abuse, program ot and outline
i (tI ClM ld ian School. "Alcoholism and Women."
ndesonJacSk ad Whitten, Lee, "Eskimo Victim of Boom", Wahingt
!. ee b diefly describing the problems the Eskimo faces -as a result of tb
tmia nacicmpanyinfg economic boom.
\W omdba Males "IndUa Akhlves," publication by Indian sinsatm
6n, M. K., Barry H., and Buckwald, C., "A Cross-Cultural Study of
ld*'iJn Junal of Study on Alcohol, Suppl. No. 3, 1965.
Siffi si a series of 5 on a study which used certain variables in an
M .Mtm' M Msoieaes, ome ef which were American Indian.
:a... i 0pg, "FIrewater, The Killer." Rio Hondo Alcoholism Coordinator,
June 11, 1973.
f!Il tc ot theauthor's ideas on why Indians drink and program modlfica-
I ttlUAB ,an Indian value system.
Baker, J.., "india., Alcohol and Homicide," Jeunal of Socal Then*
~~1%2Wl75.
S-dia4nmates atpemtenary at Leavenworth, Knsas. All homicides
tiutt while under the isuence of alcohol and author infers this evidence of
O Ivebebsvlor support the historic prohibition of alcohol to Indians.
toMfah tlM Q "rinhiag Ptteas of the Aleuts." Qu4afterly Jourwal of
tedy on Alcohol, 17 (3): 503-514 1956.
7 Kaidwe en Aeet village dl Nikolski In 1952 includes history of drinking,
_ I an t prble assMisted with the use of alcohol.
ie ibttewart, Indians and the Counte,-Cultre" Clar reek No. l8j
Deceber, 1972, 34-37. Article about the emergence of a youth- oadnter-cltoe
Mlt.etida bkh; sntny whiab found much to share with the American Indians,
SImvy tMouse of Peyote .a. d poltally.
Jtbcher, Edward, "Marijuana: The Health Question: Is Mau as damaglag
s n t wtat Make it appa Ctsw Reports, March, 1975, 14-149.
ort Uer~atd, "AlcoholisBm ad Fktal Accideetm." QU p Journal of
a,... tI O6 Ac l, septe KI M 1 -s7. A sady m alcoholism andi fatal M oidents I
SBi Ma vt 'ia m. Bome nltd v were that aloholl were sevm tma
Mffl tot t'frtd accident thas other Bay Anm reskiatbe of the me
Sad sex. It is sum wd that :ibs elevated rate is not only the etU
1 be iak e1ach: i:S btl but abo wth petsona1#y, health, life patters and
ass nuseiwed&'
* -t4 T M. "laoaoh mea, M.. ta ltfah Pnblem of Nstve Amerian,"
Archives of Geteral Psychiatry. VoL 32, Nov. 1975. A review of the literftUM
V1b %aooholKh M a major mei, tet poble among Native
.iMja. S. 8 AlmMt1 1y 1. -oi Pa. Mat twi J&mndi f!
ibNifl :4m,. t959L Unwise sway 1f kt. ut of aSeobk among ta

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78

Cockerham, William "Drinking Attitudes and Practices among Wind River
Reservation Indian Youth," Quarterly Journal of Study of Alcohol, Vol. 36,
March, 1975, 321-26. Study of Indian youth in relation to attitudes and practices
of drinking: Drinking ranked as number one source of trouble, 56% approved of
drinking, 80% considered themselves drinkers, 92% has tried alcoholic beverages.
Curley, R. T., "Drinking patterns of the Mescalero Apache" Quarterly Journal
of Study on Alcohol, 28:116-131, 1967. The cultural change exeprienced by the
Mescalero Apache historically to present in terms of alcohol and patterns of usage.
Dailey, R. C., "Alcohol and the North American Indian: Implications for the
Management of Problems", North American Association of Alcoholism Program.
17th Annual Meeting, 1966. Breaks down alcohol usage of the Indians into three
distinct stages: Accommodation, deprivation and recreation according to historical
stages. Also offers theories as to how the destructive use of alcohol can be lowvre.
Devereaux, George, "The Function of Alcohol in lMohave Society," Quarterjly
Journal of Study on Alcohol, 9:207-251, 1948. An in-depth study, using aoncete
data, concerning the Mohave culture and psychological mechanisms, Jtt; w9
found that, to date (1948), alcohol was well-integrated into both the cuitureiand
psychology. '
Dozier, E. P., "American Indian Alcoholism," Paper, University -. U mh
School of Alcohol Studies, 1964 Session. This paper gives a good background of
Indian drinking along with the patterns of styles of drinking and also the fuactionm.
Author offers some substitution activities for possible solution. .. :
Dozier, E. P., "Problem drinking among American Indians: The role of socio-
cultural deprivation" Quarterly Journal of Study on Alcohol, 27(1):72-87, 1966.
Articles deals mainly with the theory of socio-cultural deprivation in oentrfatl*o
the theories of subsistence anxiety, acculturation stress and psycho-aWalysis by
Horton, Lemut, and Devereaux, respectively. Again proposes substitutiea
activity for drinking. '
Everett, Michael W., "Anthropological expertise and the realities of Whilp
Mountain Apache Adolescent Alcoholism," Paper, Society for applied Anthro-
pology, 1973 annual meeting. Basically designs an alcoholism prevention program
taking into consideration the needs of the community as to perspectives and
attitudes about drinking. r
Everett, Michael W., "Drinking and Trouble: The Apachean Experience."
Paper, University of Kentucky Department of Anthropology. Explanation 9(
behavior among the White Mountain Apaches in regards to drinking.:
Everett, Michael W., "Verbal Conflict and Physical Violence: The Role Qf
Alcohol in Apache problem solving." Department of Anthropology, University of
Kentucky. This is a study of the White Mountain Apaches concerning the (1)
interrelating conceptual and behavioral phenomena with respect to problem
drinking; and (2) assessing the causal role of alcohol in conflict and resolution
processes .. ,
Farber, W. 0., Odeen, P. A. and Tochetter, R. A., "Indians, Law Enforcement
and Local Government," Governmental Research Bureau, State University of
South Dakota, 1957. Section on laws pertaining to alcohol-related law enforcement
problems among Indians.
Ferguson, F. N., "Navajo Drinking," Human Organization, 27 156-167, 1969
Study which divides Navajo drinkers into 2 groups; anxiety and recreation
drinkers and the prognosis of treatment for both. *.
Ferguson, F. N., "Stake in Society: Its relevance to response by Navajo Aloor
holics in a treatment program," Dissertation Thesis, University of North Carolina.
Article concerns itself with the theory of persons having a "stake" in society in
relation to other variables such as age, education and previous treatment methods
Forslund, Morris A., and Meyers, Ralph E., "Delinquency among Wind River
Reservation Youth," Criminology 12:97-106, May, 1974. 7. 1. .....
Hallowell, A. J., "Values, acculturation and Mental Health," American Journal
of Orthopsychiatry 20:732-743. October, 1950. An analytical study of how the
acculturation process has affected the values and mental health of the Ojibwa
band of Indians.
Hamer, J. H., "Acculturation stress and the functions of alcohol among the
Forest Potowatomi," Quarterly Journal of Study on Alcohol, 26:285-302,, 1965.
In this society, where acculturation stress has been severe, the reasons for heavy
drinking have been hypothesized. They. are contact with the White nmn, pre-
existing tension with spouse, belief in the curative aspects of alcohol, lack of soial
controls on drinking, and tribal individualized personality characteristics.
Hamer J. H., "Guardian spirits, alcohol and cultural defense mechanisms,"
Anthropologica 11: 215-241, 1969. A study concerning the substitution of drinking