Early modeling of drinking behavior by Native American elementary school children playing drunk.

A report of games played by elementary school children on a Native American reservation in the United States illustrates how intoxicated adult behavior is perceived as funny. Only later does one develop an awareness that the consequences of misuse can be injury, illness, and death. Prevention messages targeted at elementary school children need to provide positive alternatives to the humor in drunkenness and may need to be culturally adapted. Examples of some culturally specific approaches are discussed.

Boozing, sniffing, and toking: an overview of the past, present, and future of substance use by American Indians.

This paper provides an overview of Indian peoples, alcohol misuse, and the prevalence of drug and inhalant experience. Early use of alcohol among North American Native peoples may represent early chemical warfare to gain European advantage over an "enemy." The magnitude of the present-day problem of alcohol and substance misuse is described in mortality rates and proportionate use reports. The use of other drugs and substances, such as inhalants, amphetamines, sedatives, and hallucinogens is examined. A brief overview of the history and complex relationships between American Indians and alcohol from the time of initial contact to the present is sketched out before approaches to primary, secondary and tertiary prevention are considered. The issue of potential conflict between tribal statutes and health objectives is noted. Some possible solutions are proposed.

Expanding practice horizons: learning from American Indian patients.

The integration of Western medicine with traditional folk medical systems remains a current challenge to individuals providing patient education in American Indian and Alaska Native communities. Cross-cultural patient education requires an understanding of contemporary Indian societies' cultural patterns, including theories of disease causality and therapy. Social organization and the relationship of the community to community-based health care delivery systems are important in making education relevant to prevailing values. This article reviews the history of patient education to Indian people, highlights some of the differences between traditional and allopathic approaches to patient care, and presents a case history of a recent community-based patient education program. The article includes suggestions for practice and identifies important questions to be addressed.

American Indians, stress, and alcohol.

American Indian drinking behavior is often attributed to stress. The causal relationship of stress to Indian drinking and alcohol's role as a stressor is explored. It is likely that some drinking behavior is a response to psychosocial stressors, and that rapid ingestion or large quantity alcohol consumption may also precipitate the psychogenic stress response, thereby exacerbating stress in the individual. Using alcohol to reduce stress increases opportunities for injury and illness.