Wayne Macfadden, MD, is a co-founder of International Psychiatric Services of Philadelphia. The firm offers assistance to persons with substance abuse problems. As MD, Wayne Macfadden has a professional interest in addiction issues among Native Americans.

Many Americans associate Native Americans with problematic drinking. Tales of “firewater” reinforce the misconception that they can’t “hold their liquor” and are mostly alcoholics. Research says otherwise: the percentage of Native Americans who abstain from alcohol is higher than that of white Americans - 58 to 60 percent versus 42 to 44 percent. They also have lower abuse rates than other ethnic populations, including whites.

Before the arrival of Europeans, there was limited alcohol use among tribes. Alcoholic beverages were relatively weak and mainly used for ceremonial purposes under controlled conditions. For this reason, no sanctions against alcohol existed.

European settlers altered this balance. They frequently used “firewater” as a trading commodity and a bargaining chip in treaty negotiations. Their heavy use of alcohol and routine displays of drunk behavior provided Native Americans with a new model of consumption. This pattern of abuse was passed on to succeeding generations.

Young Native Americans often start drinking earlier and have more drinking problems than other groups. However, this can be partly accounted for by disproportionate poverty, trauma, mental health issues, and below-average access to education and healthcare.

Progress is being made. Treatment programs for Native Americans emphasize their spiritual traditions and foster a sense of connectedness to their culture. Organizations such as Native American Connections and the Indian Health Sources offer many treatment options.