In 1996, the most recent year for which data are available, alcohol consumption in
Alaska was 2.63 gallons per person1; only eight States had higher rates, many of which
are attributable to cross-border alcohol sales (Williams et al. 1998). Alaska’s consumption
rate has been among the highest in the Nation in each year for which statistics exist.
Although heavy alcohol use in Alaska is not restricted to Alaska Natives, alcohol
abuse and its consequences are disproportionately high among this group, which constitutes
approximately 15.7 percent of Alaska’s total population (Alaska Department of Labor
One theory to explain the high rates of alcohol use among this special population
faults the rapid industrialization that has taken place in Alaska. For many Alaska
Natives, conflicts involving cultural identity as well as behavioral and lifestyle
problems have resulted from adjusting to the rapid cultural changes. One way of coping
with those feelings, particularly for younger Alaska Native men and women, may be
to drink alcohol (Segal 1999).
This sidebar reviews what is known about alcohol use and alcohol-related problems
among Alaska Natives. Directions for future research on preventing and treating alcohol
abuse among this population also are discussed.
Alcohol-Related Violence and Death Among Alaska Natives
Since the late 1980s, Alaska has been among the five States with the highest annual
rates of child abuse, accidental death, assaults, rape, and suicide, all of which
have been linked to alcohol abuse (Brems 1996). For example, 25 percent of all deaths
in Alaska are alcohol-related (Alaska Department of Health and Social Services [ADHSS]
1994). More recently, of the 192 Native deaths (from any cause) that occurred in rural
Alaska between 1990 and 1993, 128 (66.6 percent) were found to be alcohol-related
(i.e., the deceased had a blood alcohol concentration [BAC] of 0.08 or higher) (Demer
1997). In addition, Alaska Native men and women exceed other ethnic groups in Alaska
with respect to alcohol-related problem behaviors, such as arrests for driving while
intoxicated (DWI), alcohol-related accidents and injuries from automobile crashes,
fishing-related accidents, and other causes of injury (ADHSS 1994).
Although all Alaskans have a higher risk of dying by accident or suicide compared
with those in the lower 48 States, the rates are notably high for Alaska Natives.
Suicides in Alaska have exceeded national rates for more than 20 years (Berman and
Leask 1994). Hlady and Middaugh (1988) reported that the percentage of suicides that
were alcohol-related in Alaska was almost twice the national average during the period
1983–1984 and that the percentage was significantly higher among Alaska Natives than
among non-Natives (Hlady and Middaugh 1988).
Alcohol-Related Health Problems Among Alaska Natives
Alaska Natives have unusually high rates of drinking, which results in many health
problems. Hisnanick (1992) reported that between 1980 and 1987, Alaska ranked fifth
among 11 Indian Health Service sites for alcohol-related illnesses and symptoms, such
as liver cirrhosis, delirium tremens (DTs), and pancreatitis.
Another alcohol-related health problem is fetal alcohol syndrome (FAS), which appears
to occur with higher frequency among Alaska Natives than among other populations.
Weeks (1989) reported an FAS rate among Alaska Natives of 5.2 cases per 1,000 births,
with regional variations of from 2.7 to 20.6 cases per 1,000 births. In comparison,
the FAS rate for the United States ranges from 1 to 3 cases per 1,000 births (May
1996). Although the reliability of some of Alaska’s FAS data has recently been questioned
(Segal 1999), the problem remains serious: In 1994, 39 percent of pregnant Alaska
Native women were estimated to be at risk for delivering a baby prenatally exposed
to alcohol or other drugs (Alaska Area Native Health Service 1995).
Correlates of Drinking Among Alaska Natives
The high rates of violence and health problems attest to the seriousness of drinking
and its effects among Alaska Natives (Brems 1996; Segal 1983a
, 1990, 1991a
, 1999; Segal and Hesselbrock 1997). Relatively little information, however, has been
reported about the factors that might underlie those problems. The next sections describe
specific areas in which research is needed to better understand alcohol use and abuse
among Alaska Natives; those areas include genetics, quantity of consumption, behavioral
and other correlates, and the possible role that a loss of Native culture may play
in problem drinking.
Until recently, it was believed that Alaska Natives were relatively recent descendants
of East Asian ancestors. If that theory were accurate, one would expect Alaska Natives
to possess a particular variant of a specific gene that has been linked to the alcohol-induced
flushing reaction2 observed in some Asians after drinking (Shibuya and Yoshida 1989;
Singh et al. 1989). This unpleasant reaction is believed to help mitigate against
heavy drinking and alcoholism (Thomasson et al. 1991). A series of studies (Avksentyuk
et al. 1994, 1995; Segal et al. 1998; Thomasson et al. 1992), however, found that
Alaska Natives do not resemble Asians with respect to this genetic trait. These findings
and other research (Segal et al. 1998; Chen et al. 1997) suggest that the genetic
characteristics that may “protect” some people against alcoholism are not present
in Alaska Natives. It is unknown, however, if Alaska Natives have a genetic factor
that may place them at particular risk for developing alcoholism. Given the disproportionately
high numbers of alcohol problems in this population it is important that this group
be included in studies searching for a genetic link to alcoholism.
Quantity of Alcohol Consumed
Alaska Natives who drink heavily may consume greater quantities of alcohol per drinking
session than their non-Native counterparts. Segal (1991a) studied repeat users of
an Anchorage “sleep-off center” (i.e., a shelter where homeless inebriates could sleep
off their intoxication) and found that the average BAC of the Alaska Natives who entered
the facility during the study period was significantly higher than that of the Caucasians
entering the shelter (0.186 versus 0.137).3 No differences in BACs were found between
genders for either ethnic group. Additional research is necessary to verify that the
pattern of alcohol consumption among Alaska Natives is different from that found in
Behavioral and Other Factors
Survey data, which compare common manifestations of alcohol abuse among Alaska Natives
and other ethnic groups, have been compiled. The table on page 278 compares Segal
and Hesselbrock’s (1997) study group of Alaska Natives with other ethnic groups on
selected behavioral and psychiatric characteristics; it shows that in many categories,
Alaska Natives present a more severe set of physical and social complications. No
research has focused on whether certain drinking behaviors are specific to Alaska
Natives. Moreover, the methodology of the alcohol studies that have been completed
in Alaska prohibits direct comparisons among ethnic groups (Hesselbrock et al. 1997).
Native women in Alaska face a much higher risk of violence than do women nationwide
(Berman and Leask 1994). The severity and nature of the violence is consistent with
other research showing a relationship between being victimized and drinking (e.g.,
Miller et al. 1993). Studies are needed to determine the effect that such family violence
has on children (e.g., does it place children at risk for abuse and neglect as well
as increase the chance that they too will abuse alcohol later in life?).
The cultures of indigenous Alaskans have been radically modified by the influx of
Russians, Anglo-Europeans, and other people, who have imposed new customs, traditions,
and economic systems. Over the past 25 to 30 years, the development of the oil industry
has spurred Alaska Natives’ transition from a subsistence to a cash economy. The resulting
alterations in family roles, community functions, and other aspects of culture may
play a role in Alaska Natives’ use of alcohol. Research will help to determine the
relationship between changing cultural mores and increased alcohol use.
Comparison of Alaska Natives With Other Ethnic Groups on Selected Characteristics
Ethnic Group (%)
Serious Alcohol Symptoms
Alcohol-Related Behavior Problems
Driving while intoxicated (DWI)
Drug Abuse/Antisocial Personality Disorder (ASPD)
The number of Alaska Native cases for this variable only is 50 males and 46 females.
Percentages are for men and women combined.
The number of cases is the same as shown at the top of the table.
NOTE: The comparison groups were derived from consecutive admissions to alcohol residential
treatment facilities who met both DSM–IV criteria for alcohol dependence and Feighner
criteria for definite alcoholism The Feighner criteria (Feighner et al. 1972) were
the first set of diagnostic criteria for alcoholism to be based on research rather
than on subjective judgment and clinical experience. They were developed in the 1970s
in response to perceived deficiencies in the first and second editions of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
SOURCES: Hesselbrock et al. 1998; Segal 1998.
Clearly, the problems associated with abusive drinking and other drug use among Alaska
Natives are severe. Sociocultural factors likely play an important role in drinking
behavior. Alaska Natives may benefit from treatment that incorporates Native values
and attitudes, although research is needed to determine whether culture-specific treatment
programs are more effective than other programs. Preliminary research on a culturally
oriented treatment program for Alaska Native women is encouraging (Segal 1998).
Future Research Directions
Treatment and prevention of alcohol problems among Alaska Natives would be enhanced
by research efforts in the following areas:
The increases in alcohol abuse and other alcohol-related problems in Alaska correspond
to a period of rapid growth and industrialization and a concomitant loss of Native
cultural traditions. Research is needed to determine whether a cause-and-effect relationship
exists between cultural loss and Alaska Natives’ alcoholism rates.
Further research is needed to demonstrate how genetic factors may predispose Alaska
Natives to alcohol problems.
Research is needed to address the risk factors, behavioral correlates, and signs and
symptoms of alcohol dependence that are specific to Alaska Natives.
Studies are needed to refine our understanding of the severe behavioral manifestations
of alcohol abuse among Alaska Natives and the connection of drinking with high rates
of violence among this population. For example, intergenerational transmission of
violent behavior is a serious problem in Alaska Native families. Future research should
explore how to treat and prevent alcohol abuse among victims of physical and sexual
abuse as well as investigate ways of breaking the cycle of violence.
Studies must be undertaken to determine if incorporating cultural factors into treatment
makes those approaches more effective. For instance, how does the increased training
and employment of Alaska Native alcoholism counselors, as well as additional cultural
training for non-Native counselors, affect treatment results with Alaska Native clients?
Prevention-based approaches are important and can be enhanced by research to improve
understanding of how cultural factors influence the initiation of drinking and drug
taking or reinforce drinking behavior once it begins.
Alcohol use has adversely affected many aspects of the Alaska Native community. To
a large extent, overcoming the problem of alcohol abuse may require that Alaska Natives
craft individual and community solutions to detrimental health, social, and economic
conditions and instill new patterns of living that inhibit alcohol abuse. An example
of this approach is the Alaska Federation of Natives’ “sobriety movement,” a grassroots
campaign to promote sobriety that emphasizes traditional values and lifestyles. The
use of “healing” or other traditional methods may help Alaska Natives both recover
from the trauma of decades of cultural conflict and address alcohol problems in their