In our study, the largest absolute burden of alcohol-induced death and the largest absolute increases occurred among AIAN individuals. National surveys indicate that AIAN individuals are less likely to drink alcohol than other groups, but those who consume alcohol are more likely to drink larger amounts and to binge drink.22,23 Within the AIAN population, alcohol misuse should be considered within the context of historical trauma and exposure to other risk factors, which include poverty, family history of alcohol use disorder, availability of alcohol at a younger age through peer groupings that include older relatives, and acculturation stress.22 Additionally, available treatment and testing interventions have largely been developed for other populations and are poorly suited to AIAN populations.21 Dramatic underfunding of the Indian Health Service and underallocation of funding for mental health and substance use disorder services are also associated with alcohol-related morbidity and mortality.24
