to those in British adolescents who have some of the highest rates of alcohol use in Europe. A study of approximately 6,000 children from the Avon Longitudinal Study of Parents and Children (ALSPAC) showed that 40% likewise began drinking at least occasionally by age 14 and at age 16 – 17 years, 60% of high frequency drinkers at age 14 had developed hazardous or harmful alcohol use in contrast to 24% of low frequency drinkers.7 Numerous studies have shown that AI/AN adolescents and adults tend to exhibit heavy episodic alcohol use8-13 and this pattern of drinking has been associated with risk for AUD and other psychiatric disorders as well as multiple behavioral problems including violence.11 An adolescent history of heavy episodic drinking in AIs has been associated with reduction in self-reported levels of intoxication in early adulthood, a potential predictor for AUD.14
