Although tribes differ with regard to the use of alcohol and drugs, the U.S. Indian Health Service has cited alcohol, tobacco and drug dependence as one of the most urgent health problems facing Native Americans [1]. Large scale U.S. epidemiological studies, demonstrate that compared to other U.S. ethnic groups Native Americans have the highest rates of alcohol and other drug dependence [2] and Native American adolescents have been shown to have the highest rates of substance use and substance-related disorders [3]. Lifetime rates of alcohol dependence, in the small number of individual tribal groups studied, have been reported as 20%–70% [4-6], higher than the epidemiological rate of DSM-IV alcohol dependence of 13% in the U.S. general population [7]. The causes for increased rates of alcohol and drug dependence in Native Americans are thought to have both environmental and genetic determinants.
