Individuals with American Indian or Alaskan Native ancestry account for 1.7% of the general US population.3 When considered as a group, AI/AN are at increased risk for alcohol-related morbidity and mortality. A Center for Disease Control survey showed that the age-adjusted alcohol-attributable death rate in AI/AN was twice that of the US general population4 but it varied by region. AI/AN in the Northern Plains had the highest death rates and Eastern AI/AN had the lowest.5 In line with this, AI/AN tend to start drinking early in life. For example, a study in 727 AI adolescents from eight reservations showed that 40% began drinking at least occasionally by age 14; of these, 59% had developed DSM-IV AUD by age 15 – 17 years in contrast to 17% of the abstainers.6 It is interesting to note that these drinking patterns are comparable 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
