Department of Family Medicine, Mercer University School of Medicine and Medical Center of Central Georgia, Macon, Georgia, USA
Received 13 February 2002; in revised form 20 May 2002; accepted 7 June 2002
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ABSTRACT |
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INTRODUCTION |
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SUBJECTS AND METHODS |
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Prior to 1945, there were no permanent Catholic or Protestant missions in the entire tribal region, and animistic religious rites were practiced. In 1945, permanent Catholic missions were built in tribal communities near the villages described in this study, and Protestant missionaries began to visit villages in the early 1990s. Outside influences escalated during the 5 years prior to the study, including the construction of both Catholic and Protestant chapels. Some villagers now participate in local Christian worship activities, although they probably represent less than half the population. One of the villages has daily transportation in and out of the nearby town. The other village enjoyed such services for a time, while attempts were made to drill for oil near the village. However, at the time of the study, transportation was available into town only on a weekly or bi-weekly basis. There are public swimming areas near each village, where outsiders from the town often come on weekends to swim. Large amounts of alcoholic beverages are consumed, and some village women sell handicrafts. Some young people from the villages go on to high school at boarding schools in other areas, and a small number have attended the university several hours away.
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RESULTS |
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Current drinking patterns
Focus group participants described significant changes in drinking patterns over the past 50 years (see Fig. 1). Families began to generate cash incomes, either by sale of cash crops or by working as day labourers on area cattle ranches or oil rigs. From their contact with other workers on the ranches, native men were introduced to beer and rum, and to the bars in the nearby towns. On payday or during harvest time, many men now go into town. In contrast to their previous village life, where no alcohol was available most days of the year, their current visits to town offer them access to large supplies of commercial alcoholic beverages in liquor stores and bars, where they may buy as much as they can afford. Many men now spend a major part of their earnings on alcohol, sometimes accompanied by fighting or visits to prostitutes. Town drinking by women is very infrequent, as most women spend the majority of their time in the village performing domestic duties. Holiday celebrations now include not only the traditional corn harvest festival, but also Christmas Eve and New Years Eve. Entire villages frequently assess a cash quota to each family, and proceeds are used to buy food, soft drinks and alcoholic beverages. In one of the villages, traditional corn liquor is occasionally brewed for festivals. Village surveys reveal that beer is now the most common beverage consumed (98% of men and 42% of women drink beer). Men are more likely than women to drink rum (58 vs 8%), while women are slightly more likely to drink corn liquor (37 vs 26%) (Seale et al., 2002
).
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Those who get drunk and fight get into legal problems. They may be locked in village jails for 1 or 2 days or be charged sizeable fines. Accidents and injuries are at times substantial. One man related a near-fatal wound from a machete. Village B men noted that others occasionally intervened in such fights to prevent severe injury.
Womens consumption patterns and perspectives on alcohol use differed from those of men. Women were more likely to abstain or begin drinking at a later age, after they had begun having children. In one village, they communicated that alcohol-related problems had decreased significantly and were no longer causing problems as they had in the past, due to the decision of the community as a whole not to buy alcohol for their annual Christmas Eve festival. Despite their feeling that problems had decreased, the group cheered when the suggestion was made to eliminate alcohol use from the community completely.
Family impact of heavy drinking
Family members described responding to heavy drinking with arguments, rebukes or threats. Wives at times separated from their husbands, although permanent separations were rare. One wife described successfully counselling her husband to drink less; another talked of policing her husband. Cycles of family violence, which were also described as occurring during traditional corn liquor festivals, continue into the present, as described by one man from Village A: It happened because the wife first hit him while he was asleep. The husband was drunk, so the wife gave him a big knot on his head. Then the husband became furious and hit her again and again and again. So the wife went and got the police in [town].
Men in both focus groups described feelings of guilt, especially over consequences of drinking on their families. One Village B man described: ... the next day, when I wake up safe and sound, the wife ... keeps after me, telling me again what happened to me ... keeps on criticizing me. Then I ... just keep quiet because ... you cant really say anything, since youre the one whos done something bad.
Why do people drink?
This question seemed to puzzle participants of each group. Numerous participants stated they did not know why they drank. The most common reason given was that others invited them, or to spend time with friends. Drinking was seen as a way to celebrate or enjoy ones self. Many of the reasons for drinking mentioned were external. Some described how others pressured them to drink. Others blamed the alcohol itself, describing it as deceptive or a betrayer. Some felt that the Black Spirit enticed them to drink. Focus group participants stated that they had learned their current drinking patterns from the White man. According to one man from Village A: Little by little, people began to get closer to the city ... Little by little, they sought out more contact with the White man. Lets say, they start working at the cattle ranch for two weeks or a month. There they earn some money. Then you know that the White man has a different kind of drink, different from ours. After [our people] are mixed with the White man, they see the White man drink. It is just like the way children learn in school.
Focus group participants frequently commented on how dramatically their culture had changed, and how many of the changes they were seeing were not good. There was a general sadness over the loss of the old ways and of good aspects of their culture that were disappearing. Nonetheless, no focus group participant described drinking due to sadness, depression or despair.
Factors which are moderating alcohol consumption
FG participants described 13 different factors that had decreased alcohol-related problems in their communities (Table 3). The most frequently mentioned problems included religious influences, recent increases in the cost of beer and rum, new village laws prohibiting the sale of alcohol in the village, counselling or education, and decisions made by community consensus such as not buying large quantities of alcohol for festivals. The most frequently mentioned factor in reducing alcohol consumption was religious involvement, primarily in evangelical village churches which offered worship experiences with a mixture of native and Western worship forms and discouraged alcohol consumption. Most participants spoke of hearing and obeying the Word of God, or of giving or committing their lives to God and being with God. One Village B woman relates: The truth is that, since I got involved here, I have nothing to do with beer, with liquor and that. Just like [our native lay pastor] ... he drank before, but now since he joined the group there, hes only with God.
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Rising cost of alcoholic beverages was also a significant factor in decreasing alcohol consumption. In both communities, men and women described how drastic increases in the cost-of-living over the previous year had greatly decreased drinking. More money was required for necessities such as food, medicines and school supplies. Little cash remained for buying beer or rum, which had also become much more expensive.
In the year prior to the study, both communities had taken steps to decrease alcohol supply in the village. In Village B, a new chief chosen by the community, established a local ordinance forbidding the sale of alcoholic beverages within the community. In Village A, it was decided by community consensus that alcoholic beverages would not be purchased for the annual Christmas Eve celebration with community funds. A Village A man described the surprising result: There was only food ... Some brought 3 cases of rum, but it was gone in just a moment. That one didnt get very drunk, the other one didnt get very drunk. And so the next day, I didnt see people in jail.
In one of the villages, counsel or advice to reduce drinking was also noted to have had an effect in decreasing drinking. Those providing advice included family members, physicians, missionaries, and others in the village who were concerned about alcohols effect on the village leaders ability to represent the interests of their community.
Suggestions for further reduction in alcohol consumption
Although some group participants were doubtful that any action would be successful in reducing alcohol-related problems in their villages, the majority suggested specific steps that they felt would further decrease problems. Greater religious commitment or involvement was the most common suggestion. One male heavy drinker from Village A described the preaching of the Word of God as the medicine for the people in regard to alcohol problems. He and others suggested more frequent worship services or more missionary presence in the village, in order to counter the daily temptation to relapse into drinking. He noted: Well, we hear the [radio dance] music every day. Then I say, "I gave myself to God but in bed I am alone and sad. Theres no one to sing [praise songs] with. Ill just join [my drinking friends] again."
Numerous individuals suggested more educational talks related to alcohol. Several felt that group meetings might be helpful, with one suggesting that a War on Alcohol group be formed, with the express purpose of confronting problem drinkers and shaming them into drinking less.
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DISCUSSION |
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Current alcohol problems appear to be related to several major influences. Long-standing drinking patterns are one influence. Indigenous peoples of South America have produced alcoholic beverages for centuries. Columbus was offered corn liquor upon his arrival in the New World (Carrizales et al., 1986). Information from our FGDs indicates that, for at least the past century, and probably much longer, individuals from this tribe have been brewing, binge-drinking to the point of disequilibrium and unconsciousness, and engaging in aggressive behaviours while intoxicated.
There are similarities with the style of drinking seen among many North American native groups, where observers have described abrupt and intense bouts of episodic or binge drinking over a period of several days (Levy and Kunitz, 1974; Hill, 1980
; Weisner et al., 1984
; Westermeyer and Baker, 1986
; Robin et al., 1998
), with episodes often ending only after money runs out or unconsciousness prevails (Curley, 1967
; Rozynko and Ferguson, 1978
; Westermeyer, 1979
). The similarities are intriguing in the light of the wide geographic separation and dramatic differences in historical exposure to alcohol between North and South American native peoples. Alcohol appears to play a role in the resolution of social tensions, a function which has also been described in US Native American groups (MacAndrew and Edgerton, 1969
). Although injuries and domestic violence are reported to have occurred, the consequences of heavy binge drinking and fighting while intoxicated on an occasional basis for periods of 23 days appear to have been quite limited in the traditional village setting. In traditional times, the primary weapon was the bow, but alcohol was unavailable most of the time. The limitations upheld by strict social norms, such as preparing only small amounts of alcohol on infrequent special occasions and restricting its preparation to individuals who met highly selective criteria, appears to have greatly limited the amount of alcohol consumed and the resultant damage caused. Subsistence farming was not disrupted and food supplies were maintained.
Historical changes related to contact with Western culture appear to have dramatically disrupted the cultural equilibrium. Western society offered virtually unlimited supplies of alcohol to those who were able to purchase it. Native men working on cattle farms observed their fellow ranch hands modelling alcohol consumption on a much more frequent basis. Gradual entry into a cash-based economy took men away from the subsistence farming which had provided a nutritional safety net for themselves and their families. Within only a few years, many native men abandoned subsistence farming for cash crops and paid employment, and spent large portions of their incomes in the bars of nearby towns once or twice a month. In the towns, the drunken men often fought with knives or firearms, waking up in the streets or in shelters, injured or in jail. They would then go home to the village without enough food to sustain their families.
One encouraging result of this study is the discovery that, as a result of the suffering, communities are establishing new norms and finding solutions. Many of their solutions local restrictions on alcohol supply, sponsorship of alcohol-free cultural events, and encouraging spiritual solutions for individuals with drinking problems parallel solutions and measures implemented in other parts of the world. Recent studies demonstrate that restrictions on alcohol supply in isolated indigenous populations are associated with reduction in injury, deaths, alcohol-related hospital visits, and out-patient clinic visits (Chiu et al., 1997; Landen et al., 1997
; Chiu and Perez, 1998
; Berman et al., 2000
). The importance of organizing and promoting alcohol-free social events has been recognized and addressed in both native and non-native prevention programmes in the USA (Marin Institute, 1992
; Komro et al., 1996
). Spiritual influences and motivation have long been recognized as an element in the recovery of individuals with substance misuse disorders (Chappel, 1998
), with spiritually oriented programmes such as Alcoholics Anonymous, demonstratably increasing abstinence rates and reducing alcohol-related problems (Tonigan, 2001
).
Sadness, despair and hopelessness, although frequently mentioned as possible causes of alcoholism among US Native Americans, were not described by FGD participants as reasons for their drinking. Poverty was the most frequently mentioned consequence of alcohol misuse, but was not once mentioned as a cause. If anything, we observed that men with higher incomes drank more, rather than less. Individuals seemed to drink as a part of being together and celebrating with others. Many men demonstrated high levels of alcohol tolerance and described feelings of loss of control typical of individuals with alcohol dependence. Whether there are also genetic factors present in this ethnic group, which might have contributed to the high prevalence of alcohol problems, deserves further study.
As the 21st century unfolds, this Native American group is taking steps to regain control over this modern plague, which has dominated its culture for the past several decades. Further reductions in alcohol-related problems will most likely result from refining the approaches that have been successful and promoting their application on a broader scale in other communities. Prevention interventions which have proven useful in communities in other countries school-based prevention programmes, increased alcohol-free recreational activities for children and adolescents, and programmes which emphasize traditional Native American cultural values could also prove useful.
One basic principle of community health and prevention that must not be lost, however, is that the most effective community interventions are initiated, planned, and implemented by the communities themselves. These native communities have already demonstrated that they are both sensitized to the problems alcohol has created in their culture and are willing to take action to regain order and harmony within their communities. It is our hope that this study will provide information that is helpful both to tribal communities and to outside agencies seeking to assist in finding permanent solutions to alcohol-related problems.
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ACKNOWLEDGEMENTS |
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FOOTNOTES |
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REFERENCES |
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