A colleague recently asked me for my opinion of the applicability of the “disease model” of alcoholism with regard to Native Americans. I knew she asked partly because my adopted children are Inyupik, from alcohol devastated families in northwestern Alaska, but also because I have worked with non-traditional ways of combating alcohol abuse for over twenty years.

After a moment’s thought I gave her the answer that has evolved out of the past forty years of my work, observations, research, discussion, and reflection. First, the repeatedly discredited “disease model” negatively impacts everyone suffering from alcohol abuse – not just Native Americans; and second, “Native American” is also a counter-productive term, one implying that there is only one homogeneous group indigenous to North America. Nothing could be farther from the reality.

Just as an example, Alaska alone is home to three distinctly different “Native” groups: Aleuts; the Yupiks and Inyupiks (”Eskimos”); and twenty seven different “Indian” tribes. Within and between these entities the degree of alcohol use and abuse varies widely and so do solutions to their alcohol related problems, just as they do to “ours.”

However, it is true that across the continent, Native Americans do exhibit a higher percentage of alcohol abuse and dependence than many other groups, though again, not in every case. But given the degree, it’s tempting to want alcoholism to be a disease, rather than looking for more complicated and less forgiving causes. But, and again, for the rest of us, these rates really are a reflection of an accumulation of numerous contributing factors.

Consider for a moment one factor: that alcohol use is largely a matter learned behaviors based on community or cultural expectations. Most of us adopt alcohol use, and abuse, patterns from our family, our community, and society at large. Who introduced alcohol to Native Americans? Prospectors, whalers, soldiers, and others whose immoderate alcohol “use” is now reflected in many of today’s Native American patterns, patterns handed down from one generation to the next.

Of course these learned patterns could be changed if they weren’t serving a purpose. Unhappily they do. In many cases being drunk is a readily accepted excuse to diverge from cultural norms – an excuse to act out aggressively rather than adhering to a passive conformity, for example. Community members hesitate to criticize someone for getting drunk and acting out this week when they may be the one wanting to get drunk and do the same next week.

Drinking is also a way of achieving some temporary respite from crowded living arrangements that don’t allow for any privacy. My neighbor on the upper Yukon was one of eight people occupying a cabin roughly fifteen by twenty feet – a cabin without electricity, running water, or any distractions. Who could blame him for disappearing into an alcohol induced stupor from time to time?

Alcohol also helps blot out the depression and frustration that comes from a seemingly hopeless future. In many communities the most capable people have left. Generation after generation has seen a steady decline in leadership, stability, and ability. In some cases nearly all of the women have left, preferring the easier life available to them with non-Native husbands, college education, or city jobs. Who can blame them for leaving, or for the hopeless young men left behind from drowning their loneliness?

In addition to personal and community factors there are also political factors. Leadership within some Native American entities is jealously held by families or individuals who see promoting alcohol abuse as a way of maintaining their positions and preventing rivals from threatening their power. “As long as they’re drunks, and their children are drunks, my children’s future is secure,” is how one Fairbanks Athabascan matriarch put it to me over twenty years ago. She was right.

The unending problem, of course, is that alcohol also makes all of the problems it “solves” worse; temporary fixes which preclude long term solutions.

Going back to my friend’s original question, viewing alcohol abuse as a “disease” makes maintaining the status quo easier for everyone. It obscures the real problems and sidetracks everyone from seeking and implementing real solutions.

But if it’s a choice, on the other hand, then changing the habits of use and abuse become matters of individual, family, community, and political choice. There aren’t a lot of people anxious to sign up for responsibility when being a victim is so much more appealing, at least for today.

The picture I have painted in this brief essay is, of course, a simplification – a picture instead of the collage that drinking patterns have created. There are individuals, communities, and tribal groups who have successfully navigated through alcohol’s destructive temptations and achieved a sober and satisfactory life. Many more could, and would, with social and political support that addressed the underlying needs and factors from a realistic perspective.

Is that apt to happen? Not as long as “treatment” reinforces the hopelessness and powerlessness that the failed treatment industry provides. Not as long as leaders externalize the causes they profit from financially and politically rather than addressing the real needs, problems, and attitudes which support continued alcohol dependence. Not as long as “alcoholism” is seen as a cause rather than a symptom. Not as long as being a victim is preferable to assuming responsibility for ourselves and for our greater communities.

No, alcohol abuse is not a disease, and the solutions – and there are many of them – are no different for Native Americans than they are for the rest of us. But it requires the courage to acknowledge the mistakes of the past, to implement real change, and to withstand the objections and sabotaging of those who profit from business as usual.